0752OF
NOTE:
With proper validation'`
this form constitutes an CITY OF - LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) .
ONE TRIP OVERSIZE LOAD PERI IT
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
7�30�go
_ Subdivision Improvement Permit — Class III
DATE- r Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S miles &dunes palms
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION - move equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
HAUL ROUTE : . �
l% miles west to wasrington north
to city limits
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
005182 0 6033 07-25-90 14
10 CASH i TOTAL i 10.00
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(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
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 applicable rules and regulations of the City of
La Quinta and to pay, for any additional replacement necessary as the result of this work.
pl_
Signature of Applicant -or Agent
���P��T�t�9A� �I�E 15030 siover fontana,CA 9233:71-4-3155-1146
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
110347
Contractor's License No. City Business License No.
UNIGARD INS. GROUP If.RX]R$ZZ XX MC -201133
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
.Public improvements: 3% of estimated_ construction costs
Private improvements: 3% of estimated construction costs �T
Minor Improvement Permit — Class IV: See attached schedule LVA 0752
Inspection Fee $
Permit Fee 10. 00
Penalty .r
Cash Deposit -Surety Bond
if required '
TOTAL:' $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED ' 7":275�;90
EXPIRATION DATE.
DATE ISSUED —
By
I*Administrative Authority
TELEPHONE: -(619) 564-2246
`
"10 2 6
CAT
CONSTRUCTION, JNC..
,15630 SLOVER' "..} ....
-
FONTANA,'CA
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PH. 714-355-1146
904OW222 ,
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PROb9CER ;'`
'THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. ,THI3 CERTIFICATE DOES NOT AMEND,
AUSTIN,COOPER & PRICE SB •` ♦
-_+�'EXTENDORALTERTHE COVERAGE AFFORDED BYTHEPOLICIES BELOW >
2131 ELKS DRIVE STE 200
COMPANIES AFFORDING COVERAGE '
SAN BERNARDINO CA,92404
_
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COMPANY A
CODE SUB-CODE
LETTER UNIGARD INSURANCE' GROUP.
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COMPANY B -
INSURED
LETTERMOAC :A r w
CATTRAC CONSTRUCTION; INC
COMPANY
STEPHANIE DINEEN �'
LETTER C; '• `. -KANSAS CITY FtIRE AND MARINE
COMPANY
P.O•'BOX- 2069
UPLAND CA 917 8 5
LETTER ',. �+' SAFECO'�SURPLUS LINES
+
COMPANY:iE'M '
LETTER s c.
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THIS IS TOCERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM
OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN-REDUCED BY PAID CLAIMS. -r
CO
POLICY EFFECTIVE
POLICY EXPIRATIO
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s�
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TYPE OF INSURANCE
-
POLICYNUMBER
DATE (MM/DO
DATE (MM/DD
ALL LIMITS IN THOUSANDS
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GENERALLIABIUTY
MC-201133_
07/07/89.08/07/90
GENERALAGGREGATE S-. 2,000
'V
COMMERCIAL GENERAL LIABILIT'
PRODUCTS-COMP/OPSAGGR is 2,000
CLAIMS MAD OCCUR.
',
PERSONAL &ADVERTISINGINJUR $ 1,000
Xt• OWN ER'S& CONTRACTOR'SPROT
EACHOCCURRENCE $ 1,000,
FIRE DAMAGE (Any one fire) _ -- 5 -50
%�•
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MEDICALEXPENSE (Any on0person S 5
AUTOMOBILE U_Aeur '
MC-201.133
07/07/89
08/O,7/90';
QOMBINEO ..
(d
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ANY AUTO r ,
SINGLE i SY::`'5:%^?:
LIMIT )R ::..::•.
1 000 :i: ;::y:%•`:rrr <::i;:
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X ALLOWNEDAUTOS
BODILY `•?jii:<%;?
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INJURY {: $ ?:•#::;:::rE2'<;ri
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$' SCHEDULED AUTOS
(Per person)
X- HIRED AUTOS
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BODILY - L's':::::%:``:::r:i:»•,`:ri:%
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X `NON-OWNED AUTOS •,
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INJURY 8
(Perecc) �.•.:. .n......;
GARAGE LIABILITY
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PROPERTY
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DAMAGE
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E;? '> #'i%: EACH AGGREGATE
EXCESS LIABILITY
CU-000538
07 O7 89 ,.
/ 07/07/89-,,0.,8/P7/90
08 O7 9O
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90THER"THAN
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"?,��0 $ 2-000
a"
UMBRELLAFORM
STATUTORY ::......
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77W835991089F
06/29/89.
06/29/90
i WORKER'S COMPENSATION
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AND • +
e''
{ '
$ (EACH ACCIDENT)
$ (DISEASE-POLICY LIMIT)' .•
EMPLOYERS' LIABILITY .
-
$ '.(DISEASE-EACH EMPLOYEE
`
B;'@ARE;O
IMC808416
07/07/89
07/07/90
$200,000 LMT .
B
IMC808416'
07/07/89
07/07/90
SPECIAL FORM se
`-
'=MD
EQUIPMENT
BINDER3737
'07/07./89
07/.07/90
�'-y$1,200,122 LMT'-
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DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS. ` s'' 4
WORKERS' COMPENSATION IS.•EXCLUDED
FROM ANY ADDITIONAL INSURED ENDORSEMENTS•.,
-WORKERS' COMPENSATION LIMIT: UNLIMITED WITHIN THE STATE OF CALIFORNIA.'
CALIFORNIA.,
:...................:....:.......:........::::::.::::::
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SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE
'
EXPIRATION DATETHEREOF; THE ISSUING COMPANY WILL ENDEAVOR TO
CITY OF. LA `.QUINTA
MAIL1�DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE
'ATT : OVERSIZE LOAD , PERMTS
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
ENGINEERING DEPT'
LIABILITY OF ANY KIND UPON THE COMPANY,ITSAGENTSORREPRESENTATIVES.
78105 CALLEFESTADO`
LA QUINTA, CA-92254.
?: AUTHORIZED REPRESENTATIVE
.:. _
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