10062 (2)See below for Finance Revenue Codes
QUM&
ENCROACHMENT PERMIT
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.
"�•►®
02�10kff Subdivision Improvement Permit - Class III
Minor Improvement Permit - Class IV
DATE: 10/5/2010
LOCATION OF CONSTRUCTION: Dune Palms Road Between Highway 111 and Avenue 48 (Former Sam's Club entrance)
PURPOSE OF CONSTRUCTION: 5 Clearing Holes for Future Signal Light Installation
DESCRIPTION OF CONSTRUCTION: Performing Clearing Holes in 5 Locations to Ensure Clearance of Existing Utilities Using Air/Vacuum Extractio
DIMENSION OF INSTALLATION OR REMOVAL: N/A
APPROXIMATE TIME WHEN WORK WILL BEGIN: 10/8/2010
TIME OF COMPLETION: 10/8/2010
ESTIMATED CONSTRUCTION COST: $4,500 (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS For CIP 2009-10
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 a d regulations of the City
of La Quinta and to pay for any additional replacement necessary as the result of this work.
SigfiattFre of Applicant or Agent
Donald Whitman
42905 Boardwalk, Ste. A, Palm Desert, CA 92211
(909) 370-0930
Name of Applicant
Business Address
Telephone No
Saf-r-Dig Utility Surveys
42905 Boardwalk, Ste. A, Palm Desert, CA 92211
800-326-0446
Name of Contractor and Job Foreman
Business Address
Telephone No.
712492
$0.00
10200
Contractor's License Number
City Business License No
Steadfast Insurance Company
GPL900536506
Applicant's Insurance Company
Policy Number
FEES Subdivision Improvement Permit - Class I
Minor Improvement Permit - Class I
Finance Revenue Code
Inspection Fee E_1
$0.00
Permit Fee E_1
$0.00
As -Built Deposit . E-A
$0.00
Cash Deposit -Surety Bond, E_B
0.00
if required
TOTAL
$0.00
Public Improvements: 3% of estimated construction costs
Private Improvements: 3% of estimated construction costs
PERMIT NUMBER: 10062
DATE ISSUED: (o - 1 1 =ly
EXPIRATION DATE: (0-0-11
BY.
i
WORK INSPECTED BY*: !'
PERMIT COMPLETION
If the work is covered by a Subdivision Improvement Agreement, Subdivider
shall request final acceptance of improvements from the City Council.