2843 (2)r
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i _' L t- / • NOTE:
•• '4' With proper validation
f this form constitutes an, f +"
encroachment permit ,, ' CITY OF LA QUINTA
APPLICATION FOR PERMIT. s
t 'N PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
f
i r For the construction of public or private. curbs, +driveways, pavements, sidewalks parking lots, sewers, water mains
Jt and other like public works improvements in connection with MINOR IMPROVEMENTS and -APPROVED SUBDIVISIONS
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4' ram% ! J� �N / �• 4 Subdivision Improvement. Permit — Class III
DATE: 1 V Minor Improvement Permit Class IV
LIST Te2q^ g�
w ] LOCATION OF CONSTRUCTION T %
r s•: �. • t••� • r , (Street address or Description of Locatio 1 r' • ' ,, - ...; : ;•` • - -
'°t. iate) a st e S I TRUCT Sketch (attach construction plans if ppropr
- �hS�t1,119U10 � �. •�
+..,. C ESCRIPTIO O C STRUC O
•,� n i DIMISIO O INSTALLA ION gEM V L / k•, /�
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a v SIZE AV ON, IF NEEDED , I�l•�iri/� ?�
t:
- APPR XIMATE TIME WHEN WORK WILL BEGIN 2•
t,APPROXIMATE TIME OF COMPLETION 3
ESTIMATED CONSTRUCTION COST $
I (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 .of '` ».`, .• ,,
r • '. _ Indemnify, -defend and sae the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
' penalties, liabilities or loss resulting from iIaims or court action gild arising out of any accident, loss or damage to persons or property
' • + ` h , . 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. n'a
' < .. •� . lComply with�all applicable City Ordinances, the terms and conditions of the permit andell applicable rules and regulations'of the City of. -
y .'la.Quinta and to pay for any additional replacement•necessa" as the result of this work.
Signature of Applicant or Age t ^�
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Name of Applicant (please print) ; • Busi
ss Address Telephon No.
P .�
Name of Contractor and Job Foreman _ ^' siness Address �.' ''+ Telephone No.
Contract ' License No.
City B siness License No.
•
COLA
Applicant's Insurance Company
Policy Number
FEES: ' Subdivision Improvement Permit - Class III
'
" Public improvements: 3% of estimated construction costs
,
'Private improvements: 3%of estimated construction costs,
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Minor Improvement Permit — Class IV: See attache schedule
• 2 7 7 4-
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Inspection Fee $ v *
PERMIT.VALIDATION
Permit Fee Icoec)0
y
•PERMIT
NO
Penalty
i?
Cash Deposit -Surety Bond
DATE APPROVED
if required
EXPIRATION DATE
TOTAL:'
'yam—f
DATE ISSUED
' Receipt No.
_
-.
-
By
Received by Date
r Administrative Authority y
�. Recorded by r
Telephone: (619) 777 7075 x
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.'EXHIBIT'° B"
'PAYS HEDtjLt
•, ,. ` THE PENINSULA AT PGA WEST
JAMES O. 'RUE CONSTRUCTION,COMPANY INC.
a
R, $• _ a 7811,418.00
_'.. 3,000.00,
V•
307,108.60 7 .
PROGRESSIVE PAYMENTS •PER- LINE -'ITEM AND JOB CODE. ALL INVOICES MUST
REFERENCE JOB CODE NUMBER.- RETENTION TO BE INVOICED, SEPARATELY. x. .
ANY CHANGE ORDERS ARE.TOBE INVOICED SEPARATELY:' L' • >, , `
a . •
y The Peninsula'at PGA Vilest