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3730NOTE: With proper 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, water mains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement Permit — Class II I DATE: 29 '�� Minor Improvement Permit Class IV x LOCATION OF CONSTRUCTION 46 080 Jefferson Street La Quints (Street address or Description of Location) PURPOSE OF CONSTRUCTION InstsllutiOn of "(;OLF CART Sketch (attach construction plans if appropriate) CROSSING" erns north and south bound DESCRIPTION OF:C.ONSTRUCTION NA Sketch to be submitted prior to installation, sera Rector Guz4a DIMENSION OF INSTALLATION"0 REMOVAL InGtall 2 each for finfil location for signs. 30" x 30" pre- gab "Golf Curt Crosaing" aims in the Right- of Way SIZE OF EXCAVATION, IF NEEDEDNA - APPROXIMATEJIME'WHEN WORK WILL BEGIN d August 2922002 APPROXIMATE TIME OF COMPLETION October 1, 2002 ESTIMATED CONSTRUCTION COST $ 500.00 (Including removal of all obstruction, materials, and debris, backfilling, com- CffyOF�QV�Nr� paction and placing permanent resurfacing and/or replacing improvements) FfNANC�®.. r 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 for 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. a Notify .the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started. w; • 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. r Signature of"Appli�cant or Agent Indian Sprius..Golf ansd Country Club 46--080 Jefferson 'St. LO 760.773.3360 Name of Applicant (please print) Business Address Telephone No. work to be done in-house Name of Contractor and Job Foreman Business Address Telephone No. NA S Contractor's License No. City Business License No. Golden Eagle Insurance Company UMB669826-00 Applicant's Insurance Company Policy Number 11 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 M0 • ,''y1A 3743-O Inspection Fee $ 15.00 PERMIT .VALIDATION' Permit Fee 100.00 , 3730 PERMIT NO. Penalty Cash Deposit -Surety Bond if required ' TOTAL: Receipt No. Received by Recorded by ,� $ ; .115:00 Date DATE APPROVED August 29, .2002. EXPIRATION DATE December 1, 2002 DATE ISSUED By Victor MOnx`; A ministrative Authority Telephone: (760),777-7075t NOTE: o With proper validation this form constitutes an encroachment permit •a 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 Subdivision Improvement Permit — Class I II DATE: `�`,�-::�"�� ;_,i ,_ Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION ,J (Street address or Description of Location) 'PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION - DIMENSION_OF INSTALLATION OR REMOVAL-- rr A SIZE OF EXCAVATION, IF NEEDED APPROXIMATETIME WHEN,WORK WILL BEGIN 2iloz tt APPROXIMATE TIME OF COMPLETION '�'` `�''`' "'"" ESTIMATED CONSTRUCTION COST$(Including removal of all obstruction, materials, and debris, backfilling, com- AF�QUINTA 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 .:C,: i_ t.`��leG✓<�c ).n,.� Name of Applicant (please print) Business Address Telephone No. 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 I I 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. Received by Recorded by Date V J PERMIT VALIDATION°L PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By�_�_,�5,r: Administrative Authority Telephone: (760) 777-7075 RECEIPT City of La Quinta, 78-495 Calle Tampico . O 1504, La Quint nATF / d_�. 20 6� RECEIVED ADDRESS DOLLARS $ //J FOR WE ,, Public. Works/Engineering Department 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7075 FAX (760) 777-7155 FACSIMILE TRANSMITTAL To: N�tL f- nrcy FAX No.. hyal,o2a S CG From: JtFAX No. (760) 777-7155 Date: 7— Z Page 1 of Comments: No/L CV Loe.9V-44w eov �e4 0 V /el 7 - Z,-. - If you did not receive all pages of this document, please call (760) 777- MAILING ADDRESS P.O. BOX 1504 LA QUINTA, CALIFORNIA 92253 T:\PWDEPTIDOCS\FORMS\FAXCOV R 1. WPD SENDING CONFIRMATION DATE AUG-29-2002 THU 10:22 NAME TEL PHONE 97753363 PAGES 1/1 START TIME : AUG-29 10:21 ELAPSED TIME 00' 32" MODE ECM RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... ° 4�a w f a4' Public Works/EngiuecringDcpartlment 78-495 Calle Tampico Lo Quima, CA 92253 (760) 777-7075 FAX (760) 777-7155 FACSTWLE TRANSNUTTAL To: /V-7" /-7"C.N 775- 93i�3 FAX No: INOl_HtY^.=�_i2 zI5 . �G From: _- �F-rOrt_ {�%ary'2._ FAX No. 17601 777-7155 Date: Page 7 of Comments;�I/A+iC.. S!y G ✓� - — }�ialJV.FGLC_9_SrI�T_Cr:} aS.�3'IXs� �!Y!/L/a�ferJ �s 51�1/ Jf you did not receive nil pages of this document, please call (760) 777- � MAJU1G ADDRESS P.O. BOX 1504 LA QIJNTA, CAlAlz0P 1A 92253 T?PWDCPTDO w.WSs—COVRI.WPD t NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCR For the construction of public or private curbs, driveways, pavements, sideJualks;: pal kii'lots, sewers, water mains and other like public works improvements in connection with MINOR IMPROVEIV(ENTS and APPROVED SUBDIVISIONS DATE:1'wGU-fl_ / Z, 2_00 Z LOCATION OF CONSTRUCTION (o _O�v (Street address or Description of Location) PURPOSE OF CONSTRUCTION IN17/a! CA027-/za11i."/ 0-- s-/G.,s - DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATI(N�%OR REMOVAL".,•'' Zi/l7ALL 7 _ 2 n 'r V �1-, !' -779.:--vQq 92 -/417 SIZE OF EXCAVATION; IF APPROXIMATE TI 5 K WILL BEGIN n Improvement Permit — Class II I nor Improvement Permit Class IV Sketch (attach construction plans if appropriate) APPROXINIAT(<TINEE OF COMPLETION ESTIMATED GONSTRU�QTIQN COST $ Via`• (Including remo'val•.:tif all 'obstruction, materials ,.-end"detiFis, Eackfilling, com- pactior -.,and 'placing permanent. resurfacing and/or- replading `tmproGements) In` coj.)sideFati6n of the granting of this permit, tha appliOnt hereby agrees to: Indemnify,` defend- and save the City, its aythc i,i ed gefits, officers, representatives and employees, harmless from and against any and all penajties,-'tiiabilities or loss resulting from lairrts_pr court action and arising out of any accident, loss or.damage to persons or property happertfng or occurring as a proximate result of any voprk .undertaken under the permit granted pursuant to this application. frfptify the Administrative Authority at least tin7errfy-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 Name of Applicant (please print) Business Address Telephone No. 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. Received by Date PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority Recorded by II Telephone: (760) 777-7075