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'Daily Inspection Report.No. City,01 La Quinta,'
Contractor AV ,
t
Sheet
Supt. on Job of
Weather G�G Date
Temperature 7T °F.Max SL °F Min. Project '
Work Hours 760 '4 to �30 Memos Issued
Photos
Special Conditions, Delays, Changes
Accidents Damage
Sampling, Testing 3
Visitors to Site
Work Report (Work done, Personnel/Equipment working),
P
By
NOTE: -
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
Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Lot 17, Iva t 2164 6 VCZ% VybC V in.tonnnec Vaci1ity, Sd2 07 615
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Cgi�otmot entry dxiyca`ooy
onto Soythcrta V 11c.
DESCRIPTION OF CONSTRUCTION 112-07_10VO utit? 'r021CC0
im,ft-ndrel croao curb 6 nuttcz.
DIMENSION OF INSTALLATION OR REMOVAL r2Ot' 2100
SIZE OF EXCAVATION, IF NEEDED 1900 PL221.
APPROXIMATE TIME WHEN WORK WILL BEGIN 11--5-90
Sketch (attach construction plans if appropriate)
1011 ATTACULD COM31TY011S.
Sr.] A1'i>P,0VED PLA71S .
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 51000-"
(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:
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.
Signature of,Applicant or Agent
PCA t'ec(r ::er ldvu of AOrsoo. lar,. P.(�. rOr 111ti 0, 1G qu-, �D, , CA 92Z53 760/771-1234
Name of Applicant (please print) Business Address • Telephone No.
U101 Buildosro 77-370 Lorog Culto Po b P.a3n Dfcoo>Lt, CA
Name of Contractor and Job Foreman Business Address Telephone No.
IG93077 1395
Contractor's License No. City Business License No.
i�rzuu�z ac�ma�a C�au 60362 27 75
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
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
`PermitFee�
r'i;KJ h-
Penalty �1R131:1.CAI
Cash Deposit -Surety Bond
if required
. TOTAL
Receipt No.
Received by ._.
Recorded•by
Date
PERMIT VALIDATION
• PERMIT NO. � = •
:,'�i
DATE APPROVED
EXPIRATION DATE
DATE ISSUED 11J3��
By
Administrative Authority
Telephone: (619) 777-7075
. f
Daily Inspection Report No.
{
City Of la.,Quinta
Contractor /=
Supt. on Job
Sheet of
Weather
Date f
Temperature OF Max
OF Min ` Project
_ Work Hours to Memos Issued
Photos
—
Special Conditions, Delays, Change's
Accidents Damage Y
i
Sampling, Testing
Visitors to Site
Work Report (Work done, Personnel/Equipment working)
Daily Inspection`Report No.
r "
44
Contractor
( rJ
Supt. onNJob
'
Sheet ' = �y ot-.
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Weather:+
Date _
Tennpereture °F Max - 52-
°F' Min
Project
Work Hours - ' �� 'A •to ��a� Memos Issued
Photos �• i t
{ ;. ' -�
' Special Conditions, Delays; Changes
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ez
Damage
-Accidents
Sampiing; Testing
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.Daily Inspection Report No. - City of La QWnt0
Contractor
Supt. on Job �"�_ - ` Sheet of
• Weather T Date ���a -1196V
Temperature 'F Max °F Min Project
Work Hours to Memos Issued
Photos .. y
Special'Conditions, Delays, Changes
Accidents Damage
Sampling, Testing
Visitors to Site
Work Report (Work done, Personnel/Equipment working) `Y
Daily Inspection Report No. C:lfy,Of LLCM Quints '
Contractor—
Supt. on Job Sheet / of -
Weather ►+/ Date ?lo Y9.9
Temperature , °F Max °F Min Proiect
Work Hours ,, Memos Issued
Photon
Special Conditions, Delays,.Changes
Accidents Damage
Sampling, Testing
Visitors to Site
Work Report (Work done, -Personnel /Equipment working)'
_ _Xe_.
With prop�r.valiclatior'.
this form. constit6tes am
CITY OF. LA'QUINTA
encroach
APPLICATION", FOR *PERMIT'
PU6LIC WORKS CONSTRUCTION
f For,t cons;tru'citicin', of -..public 6 rivate curbs driveways, 1, p . avements sidewalks', pdrking -lots,, sewers; water"mains
and otherl publi6'works improvements in connection with,MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS,
ov
address or Descri�tion'. % of Location)
so
,DESCRIPTION OF -CONSTRUCTION :'RewVe and ren1na'-P_.,_
SIZE OF EXCAVAT ION, -.IF NEEDED.
APPROXIMATE TIME WHEN WORK WILL BEGIN,.
APPROXIMATE TIME;.OF.'COMPLET
paction -�ncl placing -.per an in
eht-resurfac g and/or. replacing improvements
In consideration.of the, granting. of this. permit, the ai�pplica'nt"herebyr,agrees to: e
Anclenri AVAcl'and save the City,- its, authorized agents, 'off icers,, re
of
-penalties, liabilities';';'or loss, resulting from' 'daiirs or cc�urt, acti�o'n a"ridirising. out any. accident,- loss or damage to. pers'ons 'or, proli
happening or -occurring -as ajproxim6teresult,r6f,any work'undertakdn under the peri
the City of
'Cornply with -all'ail;lica :&;,brdinances,'the terms and conditions of the permit and all applicalble� r6liis and'reg'blations of
La Quini pi to'pa'y for any additional replacement becessary"as.*the result of this work
a- -in d F Business Address
Appli6ant,'s-Insurance Company. Pol icy Number
Public improvements: 8% of estimated construction -cdsW-
Minor Improvement Permit — Cla'ss IV: S66 attached schedule
PERMIT NO.
DATE APPROVED
Cash. Deposivsu�ety. Bond
if required EXPIRATION DATE 11/3/99,'
TOTAL: `
'
Roueict No. |
Received by
Recorded by
'-
~~' ^ '~~~^~
11/3/98
Administrative Authority
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