3748R
NOTE:
With proper validation
this form, constitutes an CITY Of LA' QUINTA
encroachment permit .
` APPLICATION FOR PERMIT
1 PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private cubs, driveways, pavements, sidewalks, parking; lots,' sewers, water mains -
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED'SOBDIVISIONS
Subdivision Improvement Permit — Class I II XX
DATE: September 18,2002 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION south side of Avenue -30 approximately 600 if east of Polo Estates
continuing 300 ft south to the entrance of Polo Eetetes
(Street address of Description of Location)
PURPOSE OF CONSTRUCTION Fattension Of 18" waterline Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
AppratImatelP 900 If of 18T' vaterliae 'in. shoulder
**SPECIAL CONDITION$ P1tOM PERMIT NO >6 t
DIMENSION OF INSTALLATION OR REMOVAL APPLY TQ, THIS VORA**
pet apQrovcd pl�e o
-
SIZE OF EXCAVATION, IF NEEDED D
As needed
APPROXIMATE TIME WHEN WORK WILL BEGIN SeptemDet 19• .2002 SEP 1 A:100Z
APPROXIMATE TIME OF COMPLETION October 19, 20tfl CITYOFLAQUIIfiA
b:.
ESTIMATED CONSTRUCTION COST $ ,t�C?q.EM1 FfNANCEDEPT.
(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: '
o.
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.
i 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 aid all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this Svork.
S'gnat eur of Applicant ofAgent
. To11 Brothers, Inc. 30-400 Jefferson tact Le Quinta, CA 92253 760.771.6076
Name of Applicant (please print) Business Address Telephone No.
Jones Brbs. Congtruction Co. P.O, Box 905 Coachella, CA 92236 760.347.2291
Name of Contractor.and Job Foreman Business Address Telephone No.
172092 03832
Contractor's License No. City Business License No.
SEE PENT NO- 3719
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement. Permit — Class 111
Public improvements: 3% of estimated construction costs
' r
Private improvements: 3% of estimated construction costs
Minor, Improvement Permit — Class IV: See attached schedule
Q
Inspection Fee $ 340.00 PERMIT, VALIDATION
Permit Fee 400,00 374E
PERMIT -NO..
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 640.00
Receipt No.
Received by Date
Reco. ded by
DATE APPROVED Sestember 18, 2002
EXPIRATION DATE September 18, 2003
DATE ISSUED�»y September 18, 2002
By
Victor MOax Administrative Authority
Telephone: (760) 777-7075
�' � "`?
'.`
Y
t � /'
NOTE:
With proper validation
this form constitutes an CITY OF LA aUINTA
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
`��' I p �V� Subdivision Improvement Permit —Class III 3Q
DATE:_ D Minor Improvement Permit, Class IV
LOCATION OF CONSTRUCTION 5-Side oc Avt 50 fox u6o LF Pas+ io -me ' Polo a;�t�s
_Q,cv Hnui nfa -IM4 Saud-h 4Z -the &i1?, fU 0C Pd1Q' aiLt'�5
(Street address d Description of Location)
PURPOSE OF -CONSTRUCTION eC'!I hlrYjoctarllhe Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION l'L NW&Af/ line
see o,-H-QGned plans
.DIMENSION OF INSTALLATION OR REMOVAL
IV' DIP rein srreei-) In di14-SVwWc1&r
SIZE OF EXCAVATION, IF NEEDEDS g5l5
APPROXIMATE TIME WHEN WORK WILL BEGIN
apt la, soda
APPROXIMATE TIME OF COMPLETION OI? Vder-k
ESTIMATED CONSTRUCTION COST $ ) 5►220- 00
(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:
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 r It of thi work.
nature of Applicant or Agent
'Tot l 5roftr�!) tYV, �b-400 kger5on 3t- L& CL� (A aaa53 j(00-.-11- i001*to
Name of Applicant (please print) Business Address Telephone No.
Jmcn)CmQ+ Co. Po I&x 6106 Coacne to , (;A q as b(o
Name of Contractor and Job Foreman Business Address Telephone No.
1 -7Wq O1Z
Contractor's License No. :City Business License No.
x
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.
$ S40 —
too
$ 40
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
Telephone: (760) 777-7075
RECEIPT City of La Quinta, 78-495 Calle Tampico,
RECEIVED
ADDRESS
FOR
1 04, La Uinta CA 92253
2
. G5422
DOLLARS $ I-%" Cy
BY
DUE