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2298NOTE - 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: 1-27-95 LOCATION OF CONSTRUCTION 54-955 Juarez Subdivision Improvement Permit — Class I I I Minor Improvement Permit Class IV (Street address or Description of Location) PURPOSE OF CONSTRUCTION Walkway to street in R/W Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Install 4 steps DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN completed at time( of hermit issuance 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: The stairway shall meet the requirements of the Department of Building & Safety The city will not be responsible for replacing the stairs should they ever need to be removed for any reason 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. YO S 426 Signature of Applicanrta, gent Nomnd Construction 54-970 Avenida Madero La Qu CA 92253 564-0602 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. 628-581 3272 Contractor's License No. City Business License No. Transamerica Insurance Group THO 2315 0774 Applicant's Insurance Company Policy Number I --1 /1 n FEES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by $ 20 10 $ 30 Date JAN 2 7 1995 2 278 . PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE 2298 1-27-96 2-25-95 DATE SU D 1-27-95 By Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 y r NOTE: With Proper validation this form constitute an % envoadhmem permit CITY OF LA OUINTA APPLICATION FOR PERMIT -PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For the Construction of public or private pubs, driveways. pavements, sidewalks. parking Iota. sewers, water mains and other like pub .fie works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS 24/^ �� Subdivision Improvement Permit — pap III DATE:- Minor Improvement Permit pap IV J LOCATION OF CONSTRUCTION — �7' ' SS U A /Y 2 L .c�_ Com, 9 z zs 3 • ISfraet addnn or Oesaspnon of L oeanonl PURPOSE OF CONSTRUCTION Ula� �a_i 70 S �/�Pt!�• Sketch (attach construction plans if a I DESCRIPTION OF CONSTRUCTION — Y s t}od iQ DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION. IF NEEDED 319 �Y APPROXIMATE TIME WNWORK�L BEGIN ; T tvvL Iff "/,t APPROXIMATE TIME OF COMPLETION -e ESTIMATED CONSTRUCTION COSTS ,L� (includingremoval of aO 6 obstruction, materials, and debris, backfilling, coat paction and placing permanent resurfacing and/or replacing improvements► In consideration of the granting of this permit, the applicant hereby ague to: Indo—itv.-defend pend, sane the City. its sudhorisad acerae, officers, repraattaUM and ampioyeaa, hamuas from and eQa1Mt cry crit! au penNtie, l abilitie «idea rerultine from tlairtb «court action and arising out of any aeeidMt, loss or darrtaea w pentons or prepnty nappo"' « �ur^na w • pro:i+sate eesutt of pry .torts undarcakm under ft petit sled pursuant to his aodicatim Noufv the Adminiriraive Auft _hy at hart tvAnry.tour (241 lbmw in advance of VW tl w when wwt Mil be started. c;on,piy with all applinbta CitY Ordinances, the sperms and Conditions Of ft parmn and all applkabb rules and La Oulnte and 1pay t« any odditlond -0--reocas+ero of the _City d� haClttary p the resent Of.thb wort. �_L i nn /n �Ai.1A11 OF It r Agent Name of Applicant (please print) Business Address Telphone No. Nance of Contractor and Job Foreman Business Address Telephorw No. x _� -) fi --5-P I 31? 7-71 Contractor's License No. City Business License No Applicant's Insurance Company GEt1. (.IABILITY Policy Number FEES: Subdivision Impronment Permit —Class III Public improvement: 3% of estimated construction costs Private improvements: 3% of estimated construction costs 1 v �j Mirror Improvemeft Permit — Class IV: See attached schedule Inspection Fee S ;FO 1 PERMIT VALIDATION Permit fee 10 PERMIT N0. Penalty Cash Deposit•Surety Bond DATE APPROVED if re fired TOTAL: s Receipt No. Received by Dab Recorded by EXPIRATION DATE DATE ISSUED BY J Administrative Authority TELEPHONE: (619) 564.2248 . 0,;?, t .' y� ` ..__ �.-_. �. y� ` ..__ �.-_. I �. y� ` ..__ .. I,r r !" � � - _ - . � ,;: • � � _ 'r _ , - � �. , �_ . y. - -s ., r i - . f _ � � �� +;.i �. - � - � ��, - c ' -.J _ �,_ • � � � . � • � �....ev... - -Send Complete(i To CITY.:.OF�LJ..QUI y �BUS INESS_ :LICENSE ` DIVI5101 :- {'.98-4.9.5 Calle.Tam ...:� � . • 1544.,.. - • La Quinta CA 92253 i ' ::*-APPROVED BY v -z * ._DATE - PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED PRIOR TO ISSUANCE Business Name: Alemolc,/ 6,y_s Xk ibn _2. _,Business Address: 411 !.{nnoh b CA -,:3. Mailing Address: A or -'B License Classification $100.00 Per Year C,License Classification $ 50.00 Per Year 9ONTR4CTORS AREON A_.CALENDAR, YEAR :BASIS ONLY; ANNUAL FROM JANUARY 1ST THROUGH _SEMI-ANIWAL F20M_-JANUARY'-"IS'P 1ST -THROUGH •: DECEMBER . 31ST -- I HEREBY CERTIFY-- that ..all -the 'information supplied by me is correct and any =licenses required by -the County, State or -Federal Government have been issued :1�to , me _ vd are in. full force and effect. •-Eus'iness Phone:(lo1/-DGO,;- 5. Owned By: CORPORATIONXPARTNERSHIP INDIVIDUAL '"; 6. ';� If .Corporation or -Partnership: .. TA,X`.I.D.# _ssi7-y�-Q,75Y ,:,7•.� '�1If--Individual Owner: Social -Security # •`--- `8.- ' Name- of "Owner -'or -'Of ficers. and Title: '-.9:' "SBEResale Number: --- 10. ' Number :of 'Decals Needed:=1Q ` 11:_ --_.CONTRACTORS_ ONLY:; -•.:COPY of STATS CONTRACToRs LICSNSS POC19T CARD IS RSOIIIRBp - _ - - A.-- .-Type of Contractor: "�.,rPh Iry - - B. Classification: i3 C.-- ; -State License Number : / I J? S Q/ /-11 A or -'B License Classification $100.00 Per Year C,License Classification $ 50.00 Per Year 9ONTR4CTORS AREON A_.CALENDAR, YEAR :BASIS ONLY; ANNUAL FROM JANUARY 1ST THROUGH _SEMI-ANIWAL F20M_-JANUARY'-"IS'P 1ST -THROUGH •: DECEMBER . 31ST -- I HEREBY CERTIFY-- that ..all -the 'information supplied by me is correct and any =licenses required by -the County, State or -Federal Government have been issued :1�to , me _ vd are in. full force and effect. RLK TEL N0.3468555 Jan 27,95 8:19 P.01 ANSAMERICA Transprotection Personal Excess e INSUMINCE GROUP Liability Policy Declarations RENEWAL Agent BOUSE—SHEFFIELD INS . Agency Code 6.43124 7. Schedule of Underlying Insurance Type of Policy Policy Period Comprehensive Personal 08-10-93/08-10-94 Liability Company, Pollcy No. Limits of Liability TRANSAMERICA INSURANCE 500,000 COMPANY. - THO 2315 0774 Automobile 11-10-93/05-10-94 TRANSAMERICA INSURANCE 500,000 COMPANY TKA 1760 1730 04-06-94 LGB DATE �j l• fK• y L 13093 C 3.9 F -� V 1859 1798 1. Name of Insured ROGER L. KRINGEN No., Street EARLENE KRINGEN. Town or City 75-641 CAMINO DE PACO State, Zip INDIAN WELLS CA 92210 L J 2. Policy Period from 04-2B—.94 to 04-28-95 12:01 a.m. Standard Time at the address of the named Insured stated herein. 3. Limits of Liability Personal Liability Coverage $ 19000P000-00 each occurrence 4. Retained Limit $ 250.00 each occurrence 5. Endorsements Form No. Title Premium L18571A Required Underlying Insurance Endorsement N/C L17546A Supplemental Provisions N/C 6. Total Premium•$ 176.00 7. Schedule of Underlying Insurance Type of Policy Policy Period Comprehensive Personal 08-10-93/08-10-94 Liability Company, Pollcy No. Limits of Liability TRANSAMERICA INSURANCE 500,000 COMPANY. - THO 2315 0774 Automobile 11-10-93/05-10-94 TRANSAMERICA INSURANCE 500,000 COMPANY TKA 1760 1730 04-06-94 LGB DATE �j l• fK• y L 13093 C 3.9