3703NOTE:
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 I I I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch attach construction plans if ( p appropriate)
.DESCRIPTION OF CONSTRUCTION_���:o�
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED w
APPROXIMATE TIME WHEN WORK WILL BEGIN
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:
l h
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 'o 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
'� � .� `y=� 1'i _ L� 1 s, \I '�i �'� 'r'�: ,i i) i i�/�, 'lA ('j?�a� -�n�� ,r\ ✓i 41!°�ri ((i 1(', Cj
Name of Applicant (please print) Business Address j Telephone No.
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iOU\IS r,.vv _�.5��✓C�. - t', ��
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 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.
$ ;��, -C�
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
\d
DATE APPROVED
EXPIRATION DATE''\",
DATE ISSUED
By
Administrative Authority
Telephone: (760) 777-7075
P.O.. Box 1504
78-495 CALLS TAMPico
LA QUINTA, CALIFORNIA 92263
July 23, 2003 * .
Century Crowell Communities
1535 South 'D' Street,. Suite 200
San Bernardino, CA 92408
Re: Encroachment Permit No. 3702 — Tract 24197-5
Street Improvement for Monticello
(760) 777-7000
(TDD) (760) 777-1227
Encroachment Permit number 3702 expired on June 30, 2003. In order to avoid the
issuance of a "Stop Work Order," please renew this permit immediately.:
The renewal fee as per City Council Resolution 96-27, states: .
Encroachment Permit — renewal of expired permit::
$100.00 plus 10% of original fee for each year
the permit has been expired
ORIGINAL PERMIT FEE
10%
EXPIRATION PENALTY
For each year permit has
been expired
$2470.75
$247.08
$100.00
RENEWAL AMOUNT DUE:
$347.08
If you have, any questions or need additional.information, please.call Jesse Jimenez at
(760) 777-7089.
Sincerely,
�"-teve Speer
Assistant City Engineer
Public Works Department
CC: Raoul Martinez, Assistant Engineer II
Jesse Jimenez, Assistant Engineer I
Permit 3702 File
WEEKLY INSPECTION REPq&
PROJECT NAMEI�a r6:f, 'DIN
I,OZ?�X��a7%
PERMIT NO. 37D 3 PLAN SET NO. INSPECTOR f'l�W Y�
CONSTR TION ACTIVITY SUMMA
YR MO DATES: thru WORK BY SPECIAL
PERMISSION
MON I TUE I WED I THU I FRI I SAT i SUN NITE
TRAFFIC CONTROL
Track -out Cleanu
Conforming imp.
Non -conforming
Earth Moving: Cut & Fill
Fine Grading
Compaction Testing/ReF
:ET IMPROVEMENTS
C&G
SUBGRADE
AGGREGATE BASE
AC - BASE LIFT
AC -'CAP
STRIPING & SIGNS
TRAFFIC SIGNAL
Compaction Testing/ReF
Material Certifications
AC Design Mb(
ER IMPROVEMENTS
MAINS
Compaction Testing/Reports
Material Certifications
SEWER IMPROVEMENTS
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MAINS
LATERALS
STRUCTURES
Compaction Testing/Reports
Material Certifications
STORM DRAIN
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MAINS
STRUCTURES
SANDFILTERS
Compaction Testing/Reports
Material Certifications
DRY UTILTIES
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STRUCTURES
Compaction Testing/Reports
Material Certifications
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