3361r T.
NOTE: I
With proper validation
this form constitutes an
encroachment permit
� �L l7Fr� •
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMEN
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water rrfains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE:. 12/15/00
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 100' a/o.Jefferson St. s/s/o Ave. 50
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION To relocate buried Verizon
facilities in conflict with St. Imp.
DESCRIPTION OF CONSTRUCTION Extend existing
facilities approximately 27' south behind new
F.O.C.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ASAP
Sketch (attach construction plans if appropriate)
See Attached Special Conditions
�TAPPROXIMATE TIME OF COMPLETION 1/10/01
.ESTIMATED CONSTRUCTION COST $ 1.300
,P1 (Including removal of all obstruction, materials, and debris, backfilling, com-
E pactio.n.,arid placing permanent resurfacing and/or replacing improvements)
' Inconsideration 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 th s work.
Signature of AppJ cant or Agent
HCI, Inc. 11201 Harel Street, Mira Loma, CA 91752
Name of Applicant (please print) Business Address Telephone No.
Larry Wilson' 343-3334
Name of Contractor and Job Foreman Business Address Telephone No.
378587
Contractor's License No.
Applicant's Insurance Company
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 $ 50
Permit Fee 100
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by _
150
Date
City Business License No.
e
Poli
MAR 2 1 2001
CITY OF LA OUINTA
t4I NCE DEPT ,
PERMIT VALIDATION
PERMIT NO. 3361
DATE APPROVED 12/15/00 t.
EXPIRATION DATE 2/15/01
DATE SUED 12115L00
Administrative Au-fi orlty
Telephone: (760) 777-7075 U
0
'. _ 'SV\
/
4
With proper validation
this form constitutes an
encroachment permit
UM
CITY OF LA QUINTA
APPLICATION FOR PERMIT
I 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
of Subdivision Improvement Permit — Class I I I
DATE: 12/15/00 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 100' e/o Jefferson St. s/s/o Ave. 50
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION To relocate buried Verizon Sketch (attach construction plans if, appropriate)
facilities in conflict with St. IMP.
DESCRIPTION OF CONSTRUCTION Extend existinft
facilities approximately 27' south behind new
F..O.C. See Attached Special Conditions
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ASAP
APPROXIMATE TIME OF COMPLETION 1/19/01
ESTIMATED CONSTRUCTION COST $ 1.300
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction arid placing permanent resurfacing and/or replacing improvements)
10consideration 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 thi's work.
nature of Applicant or Agent
HCI, Inc. 11201 Harel Street, Mira Loma, CA 91752
Name of Applicant (please print) Business Address Telephone No.
Larry Wilson 343-3334
Name of Contractor and Job Foreman Business Address Telephone No.
378587
Contractor's License No.
Applicant's Insurance Company
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 $ 50
Permit Fee 100
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 150
Date
City Busines
iini
Q 0
Policy r
AR 2 1 2001
CITY OF LA OUINTA
FINANCE DEPT
.3361
PERMIT VALIDATION
PERMIT NO. 3361
DATE APPROVED 12/15/00
EXPIRATION DATE 2/15/01
DATE,FSSUED 12/15/00
% Administrative A(u�thority
Telephone: (760) 777-7075
NOTE:.
WiVh prd validation
this form constitutes an
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,
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SU
�z el
DEC 14 2000
Subdivision Improvement Permit — Class III
DATE:- 12/11/00;: Minor Improvement Permit ClaslIVPtJ0A RKS
LOCATION OF CONSTRUCTION 100' E/O JEFFERSON ST. S/S AVENUE 50
(Street address or Oescription of Location)
PURPOSE OF CONSTRUCTION TO REL
DESCRIPTION OF CONSTRUCTION to I tNU tniZiI ilvu rr+t,il_i I it.
APPROX 27' SOUTH BEHIND NEW F.O.C.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL"BEGIN ASAP
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 01 / 1 R/f11
ESTIMATED CONSTRUCTION COSTS 1300 0543-9P203GR-169
(Inlluding.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, representaiives 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 (241 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 Quints and -to pay for any raVacs:nant ,e=c:ry as the rosiml! of this work.
Signature of Applicant or Agent
HCI INC. 11201 HARREL ST. MIRA LOMA, CA 91752
Name of Applicant (please print) Business Address Telephone No.
LARRY WILSON 760/343-3334
Name of Contractor. and Job. Foreman Business Address Telephone No.
-37'8587
Contractor's License, No: s'".^ ; ^ City Business Licence No.
"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, $
Permit Fee ,A
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
Date
PERMIT VALIDATION
PERMIT NO. -3
DATE APPROVED LI'S 0
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: 41615f34.2248-
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Administrative Authority
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