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37630 NOTE: With proper validation, �\A this form constitutes an CITY OF LA QUI•NTA encroachment permit , ` APPLICATION FOR PERMIT C' `% ' 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��..%Z (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION a DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED r 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: 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. µ&* - Signature of Applicant or Agent . . Name of Applicant (please print) Business Address Telephone No. y Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business License No. Applicant's Insurance Company 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 1-11 if required 07 TOTAL: $ ~_f Receipt No. Received by Date Recorded by Policy Numbeltr:;��rk\ „l . • • : j ACT 1 �, 2fi02 CITY OF l.fa • •�� ' iF4,�•tjG PERMIT VALIDATION PERMIT NO. DATE APPROVED � Z. EXPIRATION DATE DATE ISSUED By Administrative Authority Telephone: (760) 777-7075 �� -hp .q ��. _ A 'NOTE: 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 0 / ! Subdivision Improvement Permit — Class I II DATE: %� / `�! G' Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION' r DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDI D 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: 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. 1 Signature of Applicant or Agent //�o v 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 Lies" e �Vo. Applicant's Insurance Company Policy Numb r ocn 1 U Li FEES: Subdivision Improvement Permit — Class III OF LKQ'JRNTA CfFINANCE QGpT Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor. Improvement Permit — Class IV: See attached schedule Ir /'► Inspection Fee Permit Fee Penalty 'Cash Deposit -Surety Bond if required TOTAL: Receipt No. $ Received by Date Recorded by � # 3763 PERMIT VALIDATION LI PERMIT NO. - -/ L, DATE APPROVED /G ,��-Z_ EXPIRATION DATE DATE ISSUED f /Z' By— Administ�e Authority Telephone: (760) 777-7075 Z ® WEEKLY INSPECTION REF&T PROJECT NAME P6/✓1Pil0�c/��Fe2Sa� i2q�IGS�✓�L PERMIT NO. t-3 7(1S PLAN SET NO. DIN INSPECTOR DATE JOURNAL OF NOTABLE ACTIVITY & ACTION /.2 �9-0� 12m� o/ Gc��i�.voTed"/�tilc✓ �0a / L s w 4� i�1-�/1so•J NO�t� d u/ded N ule G,rYb �Jef Xu,JW,;-rive/ /t! IJ e!:;j2AvGot �2'' fi e/ Candu;>< �✓ cz yis�' �8 4-,.io/ ... ��w o�e5. .r/jr�c�eo/ S, c✓ C/Zo-fie �.�d �G . c /•�-sen�Gh..' .Gore oua/ `o-r�Giz� 4-?- 2e�wty.J ��eGlfZ r`C i a NOTICE SUMMARY FOR THIS WEEK: (INDICATE ONLY DATE & TYPE OF NOTICE ISSUED IN THIS SECTION) r i ov 04/02 Page 1 of 2 AGGREGATE 343-3111 REDI-MIX 3433403 AGGREGATES, INC. GEN. OFFJQE- 343-3126 P.O. Box 567, Thousand Palms, CA 92276 KOTMTS c?1()08 P.F.X. ?. 1 x.13:05 10 • 10()o0 ..TEF=FE::F'SON Y! F'C)h'IEL.(I r INDTO CA •- STATUS TODAY THIS LOAD ALL LOADS ORDERED .4 I DATE LOAD INFORMATION TRKIDRIVER -L •itTICKET c; /02 1 C") 31? t7C: NNY 102" 1 S PRODUCT INFORMATION !FUNFE ID NO. DESCRIPTION j UNIT PRICE EXT. TAX SUB. TOTAL EXTRA UNLOADING FREE UNLOADING TIME: 5 MINUTES PER YD REDI-MIX. 15 MINUTES PER LOAD DRY MATERIAL. CHARGE FOR ADDITIONAL UNLOADING TIME: $1.00 PER MINUTE. SCH. A R . ACT. ARRIVE START UNLOAD I FIN. UNLOAD JOB DEPART. PLT. ARRIV. ALLOW. MINACT. MIN X -MIN. EXT. TAX SUB. TOTAL Wil So 755 WARNING & SPECIAL INSTRUCTIONS - USE OF THIS PRODUCT WITHOUT PROTECTIVE CLOTHING COULD CAUSE BODILY INJURY. EVERY EFFORT SHOULD BE TAKEN TO AVOID CONTACT WITH SKIN. WE DO NOT GUARANTEE OUR CONCRETE FOR COLOR & STRENGTH UNLESS PROPER CURING PROCEDURES ARE FOLLOWED. k-'AST 50TH Patch I cf. 1 7,000 Cuyds Scale 7eras, sMTA I)ETYIFT0 IITPL PIN ". '1T TAFCEI a'C. 5A(40 4 i 6 Lb C 01 801) 3 "SA-1 10150 Lb 10144 SIVA 161 21 ADA3 158 tiz 159 CAL. CITE. 24 AJA4 0 Q: 0 H Naist; ASA3 2, X Maxlaaw Add (later= 70.0 gal 12 336 DE IF'TION MTFt EIN-'F 1T TW.01ET [E.UIPTIM MTRL BIN AWT TAW j c AGA2 10500 Lb 10854 3IG FEK I MAIN I1C.0 Li: 0/6 TOE V II LLT1A1 3SB0 Lb ' 3948 TYFE II 12 DW 10 Lb 0 €,M a rcim 0 60 AIR ENTMIN 23 AI AI 0 61-, 0 Ei GATEP 17 NTAI 10 Lhl 0 TAIL: WATIT 16 WTA2 15 Gal 154 A-1 AGGREGATES INC. / WEIGHMASTER Note 1) THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted, at 72200 Vista Chino, Thousands Palms, CA 92276 by a weighmaster, whose signature is on this certificate, who is a recognized authority of" accuracy, as prescribed by Chapter 7 (commencing with Section 12700) of Division 5 of the California Business and Professions code, administeWd by the Division of Measurement Standards of the California a ent of Food And Agriculture. L BY DEPUTY: Note 2) Deliveries shall be considered made when the products hereon are loaded on licensed carriers equipment as evidenced by delivery ticket(s). At that time title to the products shall pass to buyer. I hereby agree not to hold A-1 or any of its employees or carriers liable for damages inside curb or property line caused by any of their equipment, as I have requested delivery on the property for the material listed. Additional water added to this concrete will reduce its strength. Any water added is at customer's risk. Customer hereby agrees to indemnify A-1 its employees or carriers from any claim arising from such additions. /.GALS WATER AP DU Q 'sr) 9'-1*p r- q j ?J(7d ll*w5 ori-j- fowo J ro15 r/17J pYUv 1� 7'-sstvd wmV) P-� l ..", / 74Z ` SUPERIOR READY MIX CONCRETE; L.P. • Weighed at 38-155 Monroe Street Indio, CA 92201 1508 W. MISSION ROAD"• ESCONDIDO, CA 92029 PHONE:. (760) 775-82,72 • (760) 745-0556 1 I DELIVERY TICKET) 2-12780 . WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that thefollowingdescribed commodity was, weighed, measured, or counted bya weighmaster, whose signature Is on this certificate, who Is a recognized authority of accuracy, as prescribed by Chapter 7 (commencing with section 12700) of Division 5 of the California Business and. Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. DATE _ CUSTOMER NO. ORDER NO. CUSTOMER P.O. OR JOB NO. PLANT. NO. _ NO. [DELIVERYTICKET 12 / 19 / S0'2 f2s;30502 .- 381 71 7112057 CUSTOMER SPECIAL, INSTRUCTIONS y33NIIAME yy ��EEl!�� t JOB ADDRESS "F PONELO J E FF`E- RS0N ^ L A 011I YATA DESIGN - a _44"ROCK (LBS,)�, '/."ROCK (LBS.) LBS SAND ,�LBS_CEMENT I—SAPK-1—WATER71— ADD_MIX_(LBS.)— - SUPERIOR_READY MIX CONCRETE, LP. WEIGHMASTER TRUCK DRIVER 416 DAVILY, LFHMAN ��Yam' /}e .!A �• �:A•'t/"-L7"-- . DEPUTY 'CUBIC YARDS -TOTAL,C/Y DESCRIPTION..'" -- .PRODUCT CODE UNIT PRICE TAX AMOUNT 6.00 6100, 56f_—S_^.3f250 CONCRETE D85504113 _ I , eta. a YARDS TO GO *. 001. _ = In the'event of delivery beyond curb line, this company will not assume liability for damage to sidewalk, driveway, utility lines, TOTAL THIS ORDER meters, septic systems, or any other property. Materials hereby sold become property of purchaser at point of origin. The STAND-BY TIME THIS TICKET purchaser shall in no event accept deliveries of materials not in accord with the agreement of the parties, but such materials PREVIOUS STAND-BY shall be refused by the purchaser and returned to the seller with a written statement of the reason for the refusal thereof. No cancellation accepted after concrete has been loaded in carrier's'trucks at our plant. Customer is to provide for and assume responsibility for area or container for clean out of concrete truck chute. Any discharge to watercourses, street gutters or ° • stormdrains is a violation of law. Concrete is a structural building material warranteed only to meet ASTM standards. Some , imperfection as nd popoutsFinay occur for which supplier is not responsible. PLANT _ OUT UNUSUAVINCIDENT OF NOTE ON THIS DELIVERY: MAXIMUM 1 / / ,RECEIVED IN GOOD CONDITION BY: SLUMP 3.510 71' 09 N $ IN X�! / ' WATER ADDED AT CUSTOMER'S CUSTOMER SIGNATURE ON JOB UNLOADING CAUTIO�It Cement powder or freshly mixed concrete, grout or mortar may cause skin injury. Avoid REQUEST GALLONS contacAtwith skin and wash exposed skin areas promptly -with water. If any cement powder or mixture • ESTIMA-ED'SLUMP AT UNLOADING DEPART START gets into. the eyes, rinse immediately and repeatedly with water and get prompt medical attention. Keeo.cfldren away from cement powder and all freshly mixed cement products. . r .• MANY WATER ADDED TO MIX ON THE JOB WILL BE AT THE PURCHASER'S RISK INCHES ARRIVAL �'� r� g FINISH NOT R.ErONSIBLE FOR ULTIMATE DUALITY OF CONCRETE IF ANY INGREDIENTS ARE ADDED . WAITING AND/OR UNLOADING t ` AFTER L AAVING PLANT. READY Stand -by -and/or dumping time in excess of 4 minutes per yard wm oe cnargea. TIME HOUR TO UNLOAD DELIVERY