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0926*-7 111 •/ , 4 ` . , f . r � NOTE: With proper validation this form constitutes'an encroachment permit CITY OF , LA QUI'NTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) (110E TRIP OVERSIZE LOAD PERM 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 DATE: LOCATION OF CONSTRUCTION Subdivision Improvement Permit = Class I I I Minor Improvement Permit Class IV (Street address or Description of Location) c P1 IRPnSF nF MNSTR11CTlnN MOVE EQ IA I r •_ Sketch (attach constructioni lane if a ro riate) 1 DESCRIPTION OF CONSTRUCTION 0A Z EXCAVAT02 to P PP P HALAL MATE: ij 10 I -P Il iso N I V DIMENSION OF INSTALLATION OR REMOVAL 17- vVJ 119,050 � bs 3 EFF ER1, - To 5 Z ^'D SIZE OF EXCAVATION, IF NEEDED t APPROXIMATE TIME WHEN WORK WILL BEGIN "AUL DATE II-ZO - 010 APPROXIMATE TIME OF COMPLETION 'ESTIMATED CONSTRUCTION COST $ (Includirig 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: 4 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 resu t of this work. Signature of Applicant or Agent BROOK, � ASSOC P U. BOX -fl35 1 A QUINTA 6&V- 3535 - Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. DU Fay - UO 85' S, H... Contractor's License No. City Business -License No. ` DIV FI LZ ON F I L E Applicant's Insurance Company Policy Number FEES: ' Subdivision Improvement Permit — Class III8 !aiA L bTAL �0-90 iQ- i0 Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs AT - Minor. Improvement Permit — Class IV: See attached schedule N2 0.999 i Inspection Fee $ Permit Fee Penalty, Cash Deposit -Surety Bond if required TOTAL: $ I �� Receipt No. Received by Date Recorded by PERMIT VALIDATION 09 Z (10 PERMIT NO. H-7-0 90 DATE APPROVED EXPIRATION DATE I V ZD — C4D T i K- Z0 — 9 G DATE ISSUED By { Administrative Authority TELEPHONE: (619) 564-2246 e�—�:i�.^_,v. z:,'.,,.'"r+4�wMt°+°1w.�l+� re � � e+ -.r +ra r. .» � �!nl H.iM�.:�.a_.. �a-.w►.w._w Ww �.rr if h. wpM..Kw .'r r_?« ww. �w.�Y.s►w.�. ^mac � .t w �- w sw+w.. awl 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 DATE: 11 - 20 - 5 Q LOCATION OF CONSTRUCTION Subdivision Improvement Permit - Class I II Minor Improvement Permit Class IV (Street address or Description of Location) n PI IRPncF nF mKIRTRIICTInN MOVE EQUIP. Sketch (attach constructi laps if +.I DESCRIPTION OF CONSTRUCTION 0'I7 ULAYA-rO � DIMENSION OF INSTALLATION OR REMOVAL N�R A 4� I_ r), �(- iµd H r4 A I- R. SIZE OF EXCAVATION, IF NEEDED on p approprla e 1AA"L KOLATE o. L-1 b_U i A,tAh0�J -TO UEFFERSOM TO `��ZN'> APPROXIMATE TIME WHEN WORK WILL BEGIN VIA "d L DATE : 11- 2.0 _ 610 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 re si t is work. of th Signature of Applicant or Agent Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. Q U 54 - dao �44 5 �v �" 4-1 Contractor's License No. City Business License No. 4N F U E Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit - Class III 1850"i�H 8282�3�ff- i0-94 1Q�44i10 Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit - Class IV: See attached schedule Inspection Fee Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No $ 10.00 Received by Date Recorded by PERMIT NO. PERMIT VALIDATION 09? & DATE APPROVED 1 I LO i 90 EXPIRATION DATE DATEStISSUED By - Administrative Authority TELEPHONE: (619) 564-2246 i% NOTE: With prowvaiidationt, this font' constitutesan 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; waM-, rtai>n _ and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS - Subdivision Improvement Permit — Class 111 DATE: Minor Improvement Permit Classw LOCATION OF CONSTRUCTION 5a� (Street addressor Dasenption of Location)-. PURPOSE OF CONSTRUCTION LI) <' Sketch (attach construction plans if approp iia DESCRIPTION OF CONSTRUCTION �, �- �p 0 N�ENSION IVSTAL[ATION OR REMQV!{>r �)�f�► � LLnaJZTfl-toaAll 1l,c�assW�'►aur-))9 ©5� SIZE OF EXCAVA ION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris, badkfilling, com- paction.and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this. permit, the appticant hereby agrees to: I ndemnify, defend and save the City, its authorized agents, officers, representatim and employees, harmless from and against env and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persona or pramliv- happening or occurring as a proximate-rewlt of any work undertaken=under the permit granted pursuant to this application. Notify the Administrative Authority at least twenty-four 124) hours in advance of the time when. work will be started. Comoly with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of La Quints and to pay for any edditional replacement neetaary as the result of this work. CG. Signature of Applicant or Agent &x )) 3S lAloT'p, �- Shy -3s3 5. Name of Aopucant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. Contract is Ucense No. City Business License No. I Goa gb (-0 5rl bgggq - CCA Applicant's Insurance Company Policy Number FEES: Subdivision Imoroverterit Permit —Class Ill - Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor (morovement Permit — Class IV: See attached schedule y Inspection Fee S l PERMIT VALIDATION Permit Fee ?ERMIT No. Penalty i DATE APPROVED Cash Deposit -Surety Bond if required EXPIRATION DATE TOTAL:. $ I DATE ISSUED Receipt No. By Received bV Date Administrative Authority Recorded by TELEPHONE: (6191664.2246 CERTIFICATE OF INSURANCE 08/30t90TH rtificiie is . issued As a matter�of information only and confers no rights.111—tie certificate hol4er. This certificate does not amenly-elt,pd or afterPRODUCER C Letter A CIGNA Property -u Casualty' -osSfingi & Hannon Insurance 0 Pacifc Employers Group45-305 Oasis Street M Letter 2 Aetna Life,& CasualtyINSURED N ` Brooks&Ass6ciates ' E, ` P.O. Box 1135 ` S Letter E La Quinta ' CA/92253 This is to certify that policies of insurince listed below have been issued to the [nsured named above for the po(ity period indicated. -Notwithstanding any requirement; term or co6dition of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforde� by the -policies described herein is to all the terms, exclusions and 'subJect conditions of such po<iciespolicies.. Limits shown may haYe been reduced by paid.claims. -----------------------------------COVERAGES----------------------------------- � Co Type of Policy .# � Po|ic!i Po|icy . A/| Limits . Lt, Insurance � Effective Expiration � in Thousands ---_ GENERAL LIABILITY --------------------------------------------------------- 8 (X) Commercial GL 86CO5768492CCA 09/01/90 0q/01/91 6n| ASS e8ate $2,000 ( )' ( )Claims Made Prd!CompOp A38 $2,000 ' (X)OccurrencT ' Pers & Adv Inj $1,000 ( ) Owners & Contr Each Occur $1,000 Fire Damage $50 Medical Ex $5 ---- AUTOMOBILE LIABILITY ------------------------------------------ ------ B ( ) Any Auto 86FJ20557665CCA 09/01/90 09/01291 CSL $1;000 (XY All Owned B.^I./Person ( } Scheduled' 8.I./Accident ()0 Hired.' � � ' P. D. (X) Non -Owned , . ( ) Garage Liab ---- EXCESS LIABILITY ------ -------------- _------------ --------------------- �--- ( ) Umbre|{a Form �� ` ` ' Each Occur -Aggregate ( > O.T! 1Jmbrella. --�- WORKERS TION �--------------------_-------------------------------- A W.C. PWC C3585809A 09/01/90 09/01/91'STATUTORY Employers L/ab. ` ' �� � . � Each Accident $1,000 Disease/Po| $1,000 DiseaseYEmp $1,000 ---- OTHER : ------------------------ -----------------------i---------- -----------_----------_--__--_--------------------------------_--------- DESCRIPTION OF Oper.tfons/Locations/Ve ic|is7Rpstrictions/Spec\a} Items' All Operations Bus License #654 CANCELLATION: Should any Wt |he a -h -'`iibed po/)cies be'qancel)ed before"the expiration date thereof, the.issuinS company will endeavor to mail 10 days written notice to the certificate'ho|der named below _ but'. `'fai|ure to mail' such notice—shall impose no obligation or liability of'a/ y^ kind upon the company, its agents or representatives. NAME and ADDRE8S.of CERTIFICATE HOLDER City of La (3uinta ATTN: Public Works 78-105 Calle Estado C06 La Qminta, CA` 92253 ' '' Authorized Representative PAY (r)1A\.1u9-q8u9 TF|FYR7R5Rn