13022 (2)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.
Subdivision Improvement Permit - Class III
Minor Improvement Permit - Class IV
DATE: 2/20/2013
LOCATION OF CONSTRUCTION: Fred Waring Drive (County Project); Fred Waring'Drive from Adams Street to Dune Palms Road
PURPOSE OF CONSTRUCTION: Potholes
DESCRIPTION OF CONSTRUCTION: Saf-r-Dig to Locate Existing Underground Utilities Within 10" Diameter Potholes Using Vacuum/Air Extraction
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN:. 2/25/2013
TIME OF COMPLETION: 3/1/2013
ESTIMATED CONSTRUCTION COST: $21,000 (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent,resurfacing and/or replacing improvements)
COMMENTS This;Permitis'forthe,PotholesWithi.nllie'CifyRight-ofWay,ONLY
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,lInspection~Request-Hotline-at-(760)-777-7097,prior to 1:30,P-.M:�at
lea tdwehtyfour'(24) h'our`s 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.
1
1 7<
Lqy) q0b -Go&(O -I' Signature o Applicant cyAgent
-tYJ�
Saf-r-Dig Utility Surveys - Donald Whitman 12210 Michigan Ave., Ste 24, Grand Terrace, CA 92313 (909) 370-0930
Name of Applicant Business Address Telephone No
Same As Above
Name of Contractor and Job Foreman
Business Address
Telephone No.
712492 046134
Contractor's License Number City Business License No
Travelers Indemnity Co of Conn 680-3C908711
Applicant's Insurance Company 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 E_1
$0.00
Permit Fee E_1
$0.00
As -Built Deposit E-A
$0.00
Cash Deposit -Surety Bond, E_13
$0,00
if required
TOTAL
$0.00
PERMIT NUMBER: 13022
DATE ISSUED: -7-� �3
- 7
EXPIRA T (/ ATE: 2. 2-t, 1%4
BY:
WORK INSPECTED BY': Vaik`N
PERMIT COMPLETION DATE`:
If the work is covered by a Subdivision Improvement Agreement, Subdivider
shall request final acceptance of improvements from the City Council.
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