10054 (2)See below for Finance Revenue Codes
``c Evt ENCROACHMENT PERMIT
FnrOF deo PUBLIC WORKS CONSTRUCTION
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
Minor Improvement Permit - Class IV
DATE: 9/3/2010
LOCATION OF CONSTRUCTION: TM 32683; Washington Park; Simon Drive East of Washington Street
PURPOSE OF CONSTRUCTION: Installation of Sewer Laterals
DESCRIPTION OF CONSTRUCTION: Installation of Sewer Lateral
DIMENSION OF INSTALLATION OR REMOVAL: N/A
APPROXIMATE TIME WHEN WORK WILL BEGIN: 9/13/2010
ESTIMATED CONSTRUCTION COST: $10.987.50
permanent resurfacing and/or replacing improvements)
COMMENTS
TIME OF COMPLETION: 9/15/2010
(Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
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 occuring 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 at (760) 777-
7097. To submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at
least twenty-four (24) hours prior to the anticipated Inspection.
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.
Signature of Applicant or Agent
Bill Sanchez - Washington - 111, LTD 80618 Declaration Ave, Indio, CA 92201 760-485-5308
Name of Applicant Business Address 'Telephone No
Dateland Construction
Name of Contractor and Job Foreman
396698
Contractots License Number
Old Republic General Ins. Corp
Applicant's Insurance Company
83-801 Avenue 45, Indio, CA 92204 760-342-2999
Business Address Telephone No.
31
City Business License No
AlCG94111001
Policy Number
FEES Subdivision Improvement Permit - Class I Public Improvements: 3% of estimated construction costs
Minor Improvement Permit - Class I Private Improvements:. 3% of estimated construction costs
Finance Revenue Code
Inspection Fee EE=1
$330.00
Permit Fee E_1
$100.00
As -Built Deposit E-A
0.00
Cash Deposit -Surety Bond, E_13
$0.00
if required
TOTAL
I
$430.00
PERMIT NUMBS 0054
DATE ISSUED: O ��
EXPIRATION DATE:
BY: f ..L�
WORK INSPECTED BY*:_ f
PERMIT COMPLETION DA *:
If the work Is covered by a Subdivision Improvement Ogre
shall request final. acceptance of Improvements from th City CoCW OF LA