0744- iM ;.�: �''� :.: •j(i.i�` *:ti>-'V7ri .wy`" :;.�.,': (
•y
t
I
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC'WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: July 20 1990 Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Washington Street from 500 ft • north of -."47th St.
south to 61'south of Via Marquessa
(Street address or Description of Location)
PUFtPOSE OF CONSTRUCTION installation of new Sketch (attach construction plans if appropriate)
] gas main
DESCRIPTION OF CONSTRUCTION open trench entire Reference Gas Permit ' # 0650
fob to install gas pipe
ALL CONDITIONS OF PERMIT,0650
DIMENSIpN OF INSTALLATION OR REMOVAL install approxi: SHALL APPLY TO THIS PERMIT
)2164' 4" PB pipe 0744
SIZE OF EXCAVATION, IF NEEDED 2164' x 116" x 3' 4`."
dp.pn
APPROXIMATE TIME WHEN WORK WILL BEGIN Jill v 25 3 1990
APPROXIMATE TIME OF COMPLETION J111.V 3n 3 1 99n
ESTIMATED CONSTRUCTION COST $ 1'2, nnn
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend ;and save the City, ,its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties,•liabilities',o,r loss resulting from claims or court action and arising out of, any accident, loss or damage to persons or property
happening-or.`occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.,
Comply with all applicable City Ordinances, the terms and conditions of the permit and,all applicablerules and reg lations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this'..,-wrk
-Signature of Applicant or Agent
Grecr Williams 325 Ponderosa Avenue Ontario, CA 714 983-3754
Name of Applicant (please print) Business Address Telephone No.
Ace Pipeline (Billy Kilmer) same same r
Name of Contractor and Job Foreman
429473
Contractor's License No.
Business Address Telephone No.
1hR � •
City Business License No.
Llovds,of London (Arcronaut Ins) (BRL 1851) CA 20500114652
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 120.00
Permit Fee
Penalty
Cash Deposit -Surety Bond.
if required
TOTAL: $ 12n , On
Receipt No
Received by Date
Recorded by
105'18CASF� i T01•AL -i 4-90 - Q0.00 10
NQ 0744
PERMIT VALIDATION
PERMIT NO. 0744
DATE APPROVED 7/20/90
EXPIRATION DATE 8/10/90
DATE ISSUED
7/23/90
By _ ter' Tlr �iifr .lam
Administrative Authority
TELEPHONE: (619) 564-2246
.. _ - 'A:. ^Ir+'T.r-ar..-h •V. rA r+. r r • 4n r .i Y. rr Vi — — — w r r b M — — .ni !+ • wi. F r.�r r'Mr o .s .rte -r -M � al.'s nl..� ri1 a
r'
I•
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit —.Class III
DATE: July 20, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Washington Street from 500 ft north of 47th St.
south,.to 61' south of Via Marquessa
(Street address or Description of Location)
installation of new
PU6POSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
Wjgas main
DE�SCR1PTION OF C_QNSTRUCTION open trench entire
30 to install ll gas pipe
DIMENSION. OF IN§Tq� LATION OR REMOVAL Install approx.
1164 4' PB pipe
Reference Gas
ALL CONDITIONS
SHALL APPLY TO
0744
Permit # 0650
OF PERMIT 0650
THIS PERMIT
SIZE OF EXCAVATION, IF NEEDED 2164' X 1-6" X 3'4"
deen
APPROXIMATE TIME WHEN WORK WILL BEGIN Jury 25, 1990
7
APPROXIMATE TIME OF COMPLETION July 30, 1990
ESTIMATED CONSTRUCTION COST $ 12-000
(Including'removal.of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to: .
*' Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property s
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at -least twenty-four (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and,afl applicable rules and regulations of the City of
La Ouinta and to pay for any additional replacement necessary as the result of this work.
*Signature,dApplicant or Agent
r.
Greg Williams 325 Ponderosa Avenue Ontario, CA 714 983-3754
Name of Applicant (please print) Business Address Telephone No.
Ace Pipeline (Billy Filmer) same same t'
Name of Contractor and Job Foreman Business Address Telephone No.
429473 1
Contractor's License No. City Business License No.
Lloyds of London (Argonaut Ins) (BRL 1851) CA 20500114652
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
120.00
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 120.00
Receipt No.
Received by Date
Recorded by
1005102
5.i GASB i TOTAL~1 -90120.00 f0
AVS 0740 '
{
PERMITkVALIDATION
PERMIT NO. 0744
DATE APPROVED 7/20/90
EXPIRATION DATE 8/10/90
DATE ISSUED�t 7/23/90
gy rte: r/„t`i�'r..•lr,G-�
Administrative Authority
TELEPHONE: (619) 564-2246
W
II
THIS IS YOUR POCKADDENTIFICATION CARD — KEEP IT W YOU
DETACH AT PERFORATION AND FOLD y I♦ Audit No. X-230853
r
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-,CONTRACTORS STATE LICENSE_"B_OARD.
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Ur b(, H li' I I V N OF U rt MA I IUNJ/LUUA 1
ITEMS
City Of La Quinta SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED'BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING:, COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
La Quinta, CA 92253 LEFT, BUT FAILURE TO MAL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LWBILIT=
OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES.
Al)TNOR12EO PMSENTA�TIV
®-e I,
A
u
JUL-18-90 WEII 10:13 1 805 963-6898 P 02
COMPANY B ARGONAUT INSURANCE
INSURED
LETTER
COMPANY C
ACE PIPELINE COMPANY �.
c/o Alex Robertson Company
LETTER
11015 Bloomfield Ave.
COMPANY D
Santa Fe Springs, CA 9067.0
LETTER
COMPANY E
LETTER
THIS IS TO CERTIFY THAT POLICIES OF I
RANCE LISTED BELOW HAVE
BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT
M OR CONDITION OF ANY
CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSU
E AFFORDED BY THE POLICIES
DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI.
TIONS OF SUCH POLICIES.
co
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY UFECTNE
GATE (MM/00^
POLICY EXPIPATION
GTE (MMrOQNY)
LIABILITY LIMITS W THOUSANDS
EACH
O ACi(3iEGATE
GENERAL
LIABILITY
BODILY
X
COMPREHENSIVEFORM
INJURY
$
$
X
PREMISES/OPERATIONS
X
EXPESNO
PROPERTY
DAMAQE
$
$OIO&CLLAPSE
HAZARD
'
A
X
PRODUCTBICOMPLETEOOPERATIONq
BRL1851
12/389
12/31/92
X
CONTRACTUAL
BBI & P NED
$ '1,000
$ 1,000
X
INDEPENOENTCONTRACTORS
X
BROAO FORM PROPERTY DAMAGE
X
PERSONAL INJURY
PERSONAL INJURY
$ 11000
AUTOMOBILE LIABILITY
soouY
X ANY AUTO
INAIRY
(PERYH80.q
$
X ALL OWNED AUTOS (PRN. PASS.)
GMLY
B
ALLOWNEOAUTOS (ppry PAZ
CA20500114652
03/01/90
03/01/91
' AG10On'
$
HIAEO AUTOS
NON-OWNED AUTOS
PROPERTY
DAMAGE
$ '
GARAGE LIABILITY
-
CCOMBINED
$ 1,000
EXCESS
LIABILITY
UMBRELLA FORM
BI & PO
COMSINEO
$
$
OTHER THAN UMBRELLA
STATUTORY
WORKERS' COMPENSATION
$ 1,O�OtEACHluxIOBd�
B
AND
WC2048SI14678
12,/31/89
1W1190
$ 1,000(DISFASI%P(AICYUn)
EMPLOYEAS'11ABILTFY
$ 1,000(as M&FAaoOPWYM
OTHER
1'
Ur b(, H li' I I V N OF U rt MA I IUNJ/LUUA 1
ITEMS
City Of La Quinta SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED'BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING:, COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
La Quinta, CA 92253 LEFT, BUT FAILURE TO MAL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LWBILIT=
OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES.
Al)TNOR12EO PMSENTA�TIV
®-e I,
A
u
JUL-18-90 WEII 10:13 1 805 963-6898 P 02
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