11096QUA&
4-. 4,
ENCROACHMENT PERMIT
PUBLIC WORKS CONSTRUCTION
See below for Finance Revenue Codes
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.
I LES -0 COPY Subdivision Improvement Permit - Class III
Minor Improvement Permit - Class IV
DATE: 12/6/2011
LOCATION OF CONSTRUCTION: 51685 Eisenhower Drive (Lot 8 and 9)
PURPOSE OF CONSTRUCTION: CVWD; Repair 2" Copper Water Service Line
DESCRIPTION OF CONSTRUCTION: Repair Service Line
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN
ESTIMATED CONSTRUCTION.COST: N/A
12/8/2011 TIME OF COMPLETION: 12/31/2011
(Including removal of all obstruction,materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS City of La Quinta will Invoice the Permittee for T&M Expenses TBD on Material Ledger
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-foue (.24).hours.Odor 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
JA��&Appli
cantorAgent
CVWD P.O. Box 1058, Coachella, CA 92236 760-398-2651
Name of Applicant Business Address Telephone No
CVWD - Dan Fewing
Name of Contractor and Job Foreman
N/A
Contractor's License Number
Self -Insured
Applicant's Insurance Company
FEES Subdivision Improvement Permit - Class I
Minor Improvement Permit - Class
P.O. Box .1058, Coachella, CA 92236 760-832-3920
Business Address Telephone No.
Finance Revenue Code
Inspection Fee E_1
0.00
I
Permit Fee E_1
$0.00 1.
As -Built Deposit E -A0.00
Cash Deposit -Surety Bond, E -B
0.00
iif required
TOTAL
$0.00
i
N/A
City Business License No
Self -Insured
Policy Number
Public. Improvements: 3% of estimated construction costs
Private Improvements: 3% of estimated construction costs
PERMIT NUMBER: 11096
DATE ISSUED: 1Z - /y //
BY:
dw
WORK INSPECTED BY':
PERMIT COMPLETION DATE': . 79-5, ,7, D 12
If the work is covered by a Subdivision Improvement Agreement, Subdivider
shall request Mal acceptance of improvements from the City Council.
DEC -06-2011 12:06 From: 7603919638 To:917607777155 Pa9e:1,'2
4_321
0
.CATER„
COACHE'LLA VALLEY ATER DISTRICT
Post Office R )x 1058
Coachella, Calift rnia 92236
Telephone No. (7 60) 398-2651
Fax No. (760) 91-9638
F CSIMILE COVIR SHEET
Name Leonard St. ,'auver
Firm City of La Qlinta— Public •Wo ks Department
Fax No.( 760 ) 777-7155 __....�.__..
I
From Valerie Luny
s
Total number of pages sent (including transmittal) 2
Please review acid call Original to follow by mail
Yes X No
Per your request
For your information
Remarks: Please fax nennit back tn ('760)110 1 _961 R AIIn Vn1Pr;P
If you do not receive all pages or they are not legible,
Ask for Valerie Ext. 3529
Date 12/6/2011 1 Thn.e
ise call as soon as possible.
:O1 PM
CVWD-133
(Rev. 1/03)