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3819
st NOTE:.' Witeproper vafidation 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% jau, uary 15. 2003 Minor Improvement Permit Class IV ' LOCATION OF CONSTRUCTION La Ponda & 3ucumba Civic 'Center Campus (Street address or Description of Location) PURPOSE OF CONSTRUCTION Huai Patch criDe6inlit Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Trench Fatah <.DIMENSION.OF INSTALLATION OR REMOVAL200 SIP SIZE:OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN JARR►r9 16. 2003 APPROXIMATE TIME OF COMPLETION January 17, 2003 ESTI'M.ATED CONSTRUCTION COST $ 10,000 (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 Y`a ' penalties,".liabilities or loss resulting from claims or court action and arising out, of any accident, loss or damage to persons. or property: 1 happening or, occurring as a proximate result•of any work undertaken under the permit grantedgpursuant to this application. ' •Notify the -Administrative Authority at least twenty-four (24) hours in advice of the time when work.will be started. f s 0 Comply with all applicable City Ordinances, the terms and conditionthe permit and all applicable rules and regulations of the City of I . -La Quinta and to pay for any additional replacement necessary a .thef'refsult of tl',is work. ft. Ili If, A Ills t sae Zottan Grading & P Name. of,Applicant.(please print) Inc of Applicant orA�gent--/ td., Whitey4ter, Qk (760) 251-5113 Telephone No. Bob Zo l same as above. (760i 86146.34 - Name of Contractor and Job Foreman Business Address Telephone No, ' 746535'. 03857 Contractor's License No. City Business License No. Steadfast Co. 020126538586 Applicant's Insurance Company Policy Number FEES: 'Subdivision Improvement Permit — Class III Public, improvements: 3%of'estimated construct ion. costs., Private improvements: 3% of estimated construction costs Minor. Improvement Permit — Class.IV: See attached schedule r r 3819 .•,. Inspection Fee $ PERMIT VALIDATION Permit Fee II 3$19 Penalty Cash Deposit -Surety Bond if required TOTAL: $ ' NO FEE Receipt No, Received by Date Recorded by Business Address. PERMIT NO. .DATE APPROVED January 15, .2003 EXPIRATION DATE April 15, 2003 DATE ISSUED. � 3axa'uary, 1,5, 2003 ,a i Administrative Authority Sauver, Ascistant Engineer I Telephone: (760) 777-7075 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 Subdivision Improvement Permit —Class II I DATE: .yd3Ysi2ory 15. 2003 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION©n'IClCIat Cca�� C'P (Street address or Description of Location) PURPOSE OF CONSTRUCTION 22L3 '� �� "" ��* CC Sketch (attach construction plans if appropriate) ' DESCRIPTION OF CONSTRUCTION -2 2b DIMENSION OF INSTALLATION OR REMOVAL' t! . F SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 10-11 AKY 16, 2007 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;Jthe permit and all applicabld�rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as, the result of this .work. s IL /Signature of Applicant or,Agent r ._ . Zoltaon GradftG 6 Ptv$,noo lue. 15050 chollo rhtcg�7atar* C1.'% Q60), 252_91I3 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Toreman Business Address Telephone No. 746535 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 Date Recorded by PERMIT VALIDATION PERMIT NO.�� DATE APPROVED '� � 2.003 EXPIRATION DATE DATE ISSUED 3Qtwor'� 1% 41003 By — Administrative Authority Telephone: (760) 777-7075 °