3733 (2)r �
NOT%
Wilt','i N,oper 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 I I I
DATE: A>ur*ttat 30. 7007. Minor Improvement Permit Class IV %r
LOCATION OF CONSTRUCTION CIP Project La Quinta Civic Park near City Hall
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Inutrllntion of (2) oach
5" co-duita
DESCRIPTION OF CONSTRUCTION Hive rnd replaco AC
ene"watr, , inett. 1 (2)--5" condui.ta -
br ckf •! ll and ccmorc i .
DIMENSION OF INSTALLATION OR REMOVAL
Derr the contract dowjzf!ntn
SIZE OF EXCAVATION, IF NEEDED an nnnOnd
APPROXIMATE TIME WHEN WORK WILL BEGIN Snntr+ bEr 3. 2002
APPROXIMATE TIME OF COMPLETION 45 tm I+{na dn,gn
ESTIMATED CONSTRUCTION COST $ 9-onn..66
(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:
Sketch (attach construction plans if appropriate)
**All aork to be performed in strict
accordance with the contract documents
held by the General Contractor with
the City of La Quints.**
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 rule and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result o this work.
Signature of Applicant or Agent
Tri Star Bncavation PO Box 542 Cathedral Ciyvi CA 760.321.0898
Name of Applicant (please print) Business Address Telephone No.
Larry Ouenu/Chuclt Hurt cams an above
Name of Contractor and Job Foreman Business Address Telephone No.
477513 A/B 00762
Contractor's License No.^��, City Business License No. v State Duna 044-0019798 - 000a7
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 $ �Itk
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ NA
Receipt No.
Received by Date
Recorded by
PERMIT NO.
PERMIT VALIDATION
3733
DATE APPROVED AuBuct 30, 2002
EXPIRATION DATE
December 1, 2002
DATE ISSUED. kugust 30, 2002
By
Victor ',!on:. AOministrative Authority
Telephone: (760) 777-7075
NOTE:
With i
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 II
DATE: A.uguat 30, 2002 Minor Improvement Permit Class IV "
LOCATION OF CONSTRUCTION CIP PrOJOC e: La Quinta Civic 'ark no&r City Hall
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION xnata:ll "On of (2) each Sketch (attach construction plans if appropriate)
5" conduits
DESCRIPTION OF CONSTRUCTION Remove and ravlace AC "All work to be Performed in strict
PaV6Z6Ar, excavate, install W -S" conduits, ticcordanca With t b* contrleat documonts
backfill and coa}p4ct. hold by the General Contractor With
DIMENSION OF INSTALLATION OR REMOVAL tbo City of LA Quint&,,**
per the contract dr►emento
SIZE OF EXCAVATION, IF NEEDED needed
APPROXIMATE TIME WHEN WORK WILL BEGIN Souteaber 3* 2002
APPROXIMATE TIME OF COMPLETION 43 workina dava
ESTIMATED CONSTRUCTION COST $ 9*400•40
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing.improve.ments)
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 workpwill be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rule hand regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result o this work.
Signature of Applicant or Agent
Tri $tot . Bzaaya Lion PO Ibex 5+42 Cathedral City, CA' 760.321. d898
Name of Applicant (please print) Business Address Telephone No.
L*rry Ovens/Chuck Hurt Sam as above
Name of Contractor and Job Foreman Business Address Telephone No.
477315 A/B 00762
Contractor's License No. City Business License No. !
State Fund 044-0019798
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 $ "in
Permit Fee HA
Penalty �»
Cash Deposit -Surety Bond
if required
TOTAL:. $ NA.
Receipt No.
a
Received by Date
NP 3T33
PERMIT VALIDATION
PERMIT NO. 3733
DATE APPROVED August 30' 2002
EXPIRATION DATE Dee Aber 1, 2002
DATE ISSUED August 30, 2002
By Victor ]<" bvkz Ad-'inistrative Authority
Recorded by Telephone: (760) 777-7075