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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 Subdivision Improvement Permit — Class II I DATE: ' 112)- 91 Minor Improvement Permit Class IV- Sq - V LOCATION OF CONSTRUCTION S y ' y 20 D 1 Z - • : ' (Street address or Description of 'Location) PURPOSE OF CONSTRUCTION oI; �vE�1�ifIY ' APPf�6ACtt Sketch (attach construction plans if aoorooriate) DESCRIPTION OF CONSTRUCTION P ER RiU E.�51 CO • S_:Tb N D . Z07 (ATTRCI-4 F_ ) DIMENSION OF INSTALLATION OR REMOVAL X SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN A-oAP'' 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'tindertaken 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 applicablejrules and regulations of the City of La Quinta and to pay for any additional replacement necessary. as the result of this work. �- Signature of Applicant or Agent - MIKE 4.4EAD y Name of Applicant'(please print) Business Address Telephone No. A�1QZEA50J e0A)ST P 0, Bax )6'01. L• Q.'' S&Y - Z00,3 Name of Contractor and Job Foreman Business Address Telephone No. FD7)g1 Z.a S7� Contractor's License No. City Business License No. zSA IZC I A INS . TIIJC . - EPA /I &0 I qL4 / Applicant's Insurance Company Policy Number g i FEES: Subdivision Improvement Permit = Class III• ' ?8518EAN �3RAL^iS-g1 30.06'0 Public improvements: 3% of estimated construction costs Private improvements:,3% of estimated construction costs,' Minor Improvement Permit — Class IV: See attached schedule.• 1 Inspection Fee $ Z'0-00 PERMIT. VALIDATION Permit Fee . 10, oQ II * 0, 9 s a ' PERMIT NO. DATE APPROVED IS r EXPIRATION DATE IJ `9,l DATE ISSUED I ' By I& Administrative Authority Penalty Cash Deposit -Surety Bond if required TOTAL: $ �� w Receipt No. _ Received by Recorded by Date i TELEPHONE: (619) 564-2246 yap�y.Ory per:' �K'��e.M �w t 6 Yb�d r� N w R�. �► qi' /1•�"R4-a.• 4.:. @cT� l� K. V,F.T" l�f i_r ; � 1Y Vf �� w moi' F� 4Y�P. MSA JI► w.4.4 w alb ll� N 3t. M Ye.1�t �M 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 "'`t - I lb- 91 Subdivision Improvement Permit - Class I II Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION G+- - q ZD DIA Z (Street address or Description of Location) 1 �A �!l p PI IRpf)CF nr: Cf)NSTRI ICTmN DUVE AY APPOAl""[�LL Sketch (attach construction Inns If n ro riate) DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL a A 18 SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN k�'AP 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: P PP P PER K!UUADE CO IE-STEll N D . 2-07 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. �c Signature of Applicant or Agent NkIKE HEAD Name of Applicant (please print) Business Address Telephone No. AtJDZEA'56AJ eoNST tr 6 6 x )(,e,SE L.Q. IstnY- ZD® Name of Contractor and Job Foreman Business Address 'Telephone No. F07)g1Z 578 Contractor's License No. City Business License No. Z:;A?,C-IA SMS TUC- EPA/1(W P1q/ Applicant's Insurance Company Policy Number S FEES: Subdivision Improvement Permit - Class II I ?85'8FaiA. ���'�jTk-AB-�i 30.0(50 Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit - Class IV: See attached schedule Inspection Fee $ 2"0 ' 00 Permit Fee 10.00 Penalty Cash Deposit -Surety Bond if. required TOTAL: Receipt No. Received by Date PERMIT NO PERMIT VALIDATION 09aS DATE APPROVED EXPIRATION DATE /- Z - 9/ DATE ISSUED 1-121- 9 By /fit /.,!l i '� r�r�`✓�� �"-. Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 pnoouosn ISSUE DATE (MmmoY) 1/11/91 THIS CERTIFICATE mISSUED INFORMATION ONLY AND CONFERS woRIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT Awcwo, EXTEND onALTER THE COVERAGE AFFORDED ovTHE POLICIES BELOW. THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY psnmo INDICATED, NOTWITHSTANDING ANY RED UIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE O'HEREI N IS SUBJECT TO ALL THE TERMS,- EXCLUSIONS, AND CONDI- TIONS OF SUCH POLICIES. co LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDfYY) POLICY EXPIRATION DATE (MWOOtYY) Cl v ....7 COMPANIES AFFORDING COVERAGE NERAL AGGREGATE COMPANY LETTER A INSURED PRODUCTS-COMPIOPS AGGREGATE $ C)I COMPANY n LETTER ma CLAIMS MADE OCCURRENCE COMPANY LETTER C OWNER*S & CONTRACTORS PROTECTIVE EACH OCCURRENCE $ 1 9 COMPANY LETTER E THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY psnmo INDICATED, NOTWITHSTANDING ANY RED UIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE O'HEREI N IS SUBJECT TO ALL THE TERMS,- EXCLUSIONS, AND CONDI- TIONS OF SUCH POLICIES. co LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDfYY) POLICY EXPIRATION DATE (MWOOtYY) ALL LIMITS IN THOUSANDS NERAL AGGREGATE COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOPS AGGREGATE $ C)I CLAIMS MADE OCCURRENCE PERSONAL & ADVERTISING INJURY %j OWNER*S & CONTRACTORS PROTECTIVE EACH OCCURRENCE $ 1 9 FIRE DAMAGE (ANY ONE FIRE) $ MEDICAL EXPENSE (ANY ONE PERSON) AUTOMOBILE LIABILITY ANY AUTO GSL $ ALL OWNED AUTOS P. BODILY NJURY SCHEDULED AUTOS �PER PERSON) HIRED AUTOS BODILY INJURY NON -OWNED AUTOS ER C 'DENT) $ GARAGE LIABILITY H PROPERTY DAMAGE $ EXCESS LIABILITY EACH AGGREGATE OCCURRENCE OTHER THAN UMBRELLA FORM STATUTORY WORKERS' COMPENSATION $ C) C.) C.) (EACH ACCIDENT) AND C. X`,C) (DISEASE -POLICY LIMIT) EMPLOYERS' LIABILITY (";0C $ (DISEASE -EACH EMPLOYEE) OTHER DESCRIPTION opOPERATIONS/ LOCATIONS/ VEHICLES/ RESTRICTIONS/ SPECIAL ITEMS OPERATIONS PERFORMED BY NAMED- FOR OR ON BEHALF OF CERTIFICATE HOLDER AT BIGHORN PALM DESERT CA BLUEBIRD MASONRY P O BOX 1138 PALM DESERT CA AN W0R10' 25'S 11/85 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Ek PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1. ODAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY AINP�^N THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 92261 NOTE: } y With proper validation this form constitutes an ' CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT' " PUBLIC WORKS -'CONSTRUCTION (ENCROACHMENT) 4 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: L Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of.Locatio'n) • PURPOSE OF CONSTRUCTION- , f [� &_-ia4Z Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION ` j6 0 DIMENSION OF INSTALLATION OR REMOVAL ! f --Ye— tali z� 'SIZE OF EXCAVATION, IF. NEEDED - APPROXIMATE TIME WHEN WORK WILL BEGIN . APPROXIMATE TIME OF COMPLETION ,. ESTIMATED CONSTRUCTION COST $ ' / ' (Including removal of all obstruction, materials, and debris, bawkfilling, com- paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit, the applicant hereby agre'es.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 1 happening or occurring as a proximate result of any work ,undertaken under the permit granted pursuant to this application.. , Notify the Administrative Authority atdeast 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. s vx /6irr•/Si nature of Applicant or Agent o 2a 3 1600 /12: X61 ct Name of Applicant (please print) Business Address" • Telephone No. Name of Contractor and Job Business Address Telephone No. FIs 0/16 ' ` 071Y 1Y /--1 8 f 5 - C tractqr's License -No. t _ City Business License No. 1­7 ;y- p `'cant's Insurance Company Policy Number FEES: Subdivision Improvement emit---EFass+ll ■, u Ic improvements. o o estimate construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit —Class IV:'See attached schedule - 'Inspection Fee $ II Permit Fee t Penalty Cash Deposit-Surety'Bond if required TOTAL: $ Receipt No. Received by Date Recorded by' N•O . r PERMIT VALIDATION PERMITtNO. DATE APPROVED EXPIRATION DATE DATE ISSUED By .. Administrative Authority TELEPHONE: (619) 5642246 '