3311MOTE: '
With proper validation
this form constitutes an
encroachment permit
• or
CITY OF LA QUINTA
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
9/29/00
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION W/S of Ave. Bermudas approx. 200' s/o of Calle Sonora
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Excavate blacktop to access Sketch (attach construction plans if appropriate)
Verizon conduit system to repair damage ducts
DESCRIPTION OF CONSTRUCTION Remove asphalt repair
damaged ducts replace & restore to original
See Attached Conditions
DIMENSION OF INSTALLATION OR REMOVAL Ver. W.O. #0543-3FOOlAP
6' x 12'
SIZE OF EXCAVATION, IF NEEDED
6' x 12' PAID
1
APPROXIMATE TIME WHEN WORK WILL BEGIN 10/15/00
APPROXIMATE TIME OF COMPLETION 10/22/00 OCT 0 9 2000
ESTIMATED CONSTRUCTION COST $ 1.500 XY lit- LA ,
(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: a,
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 oft s work.
Signature of Applicallft or Agent
HCI. Inc.
Name of Applicant (please print) Business Address Telephone No.
Larry Wilson 11201 Harrell St. Mira T,otna,. CA. 91752 343-3334
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor. Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 150
Permit Fee 100
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 95C
Receipt No.
Received by
Recorded by
Date
3311
PERMIT VALIDATION
PERMIT NO. 3311
DATE APPROVED ' 9/28/00
EXPIRATION DATE 12/31/00
DATE ISSUED r7 9/29/00
Administrative Authority
Telephone: (760) 777-7075
NOTE:
With- ,proper validation
this form constitutes an
OA
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
. -PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and otherAike public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE
9/29/00
Subdivision Improvement Permit —Class II I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION W/S of Ave. Bermudas approx. 200' s/o of Calle Sonora
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Excavate blaCktop to access Sketch (attach construction plans if appropriate)
Verizon conduit system to repair damage ducts
DESCRIPTION OF CONSTRUCTION Remove asphalt repair
damaged ducts replace 6 restore to original
See Attached Conditions
DIMENSION OF INSTALLATION OR REMOVAL Ver. W.O. #0543-3FOOIAP
6' x 12' >�
SIZE OF EXCAVATION, IF NEEDED
6' x 12' PAID
APPROXIMATE TIME WHEN WORK WILL BEGIN 10/15/00
APPROXIMATE TIME OF COMPLETION 10/22/00 OCT 0 9 2
ESTIMATED CONSTRUCTION COST $ 1.500 LA
WWI
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Ilk
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 oft 's work.
Signature of Applica t or Agent
HC1. Inc.
Name of Applicant (please print) Business Address Telephone No.
Larry Wilson 11201 Harrell St. Mira Lama. CA 91752 343-3334
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
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.
$ 150
100
$ 250
Received by Date
Recorded by
3311
PERMIT VALIDATION
PERMIT NO. 3311
DATE APPROVED 9/28/00
EXPIRATION DATE 12/31/00
DATE ISSUE 9/29/00
By
` r Administrative Authority
Telephone: (760) 777-7075