4044s . NOTE: 1
With proper validation 4 Q
• O
this.form constitutes an
encroachment permit
CITY'.OF `LAOU.INTA
APPLICATION FOR PERMIT
PUBLIC WORKS- CONSTRUCTION .(ENCROACHMENT).
OF TRB9
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 III
DATE: DecaYnt9eX 21 j, 2003 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION AVenue 58 6 Madiaon Street w .Tract. # 30487
(Street address or'Description of Location)
PURPOSE OF CONSTRUCTION Tetnupxaxv Water Sketch (attach construction plans -if appropriate)
DESCRIPTION'OF CONSTRUCTION 8" teMota.ry water l.init
'*See. 4ttached special ' conditIbAs*
DIMENSION OF INSTALLATION OR REMOVAL1 600 feet
SIZE OF EXCAVATION, I.F NEEDED
APPROXIMATE TIME WHEN WORK.WILL BEGIN 12/''17/03
APPROXIMATE TIME, OF COMPLETION 12/19/0
ESTIMATED CONSTRUCTION COST $ 2"100.00
(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 authorised agents,. officers,, :representatives and employees, harmless from and,against•any and all
penalties, liabilities 'or loss" resulting from claims or -court action andarising 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, 11 time when work Will be started.
Comply with all, applicable City Ordinances, the terms. and 'conditions of the permiVand all applicable rules and regulations of the City of
La Pdinta and to pay, for any additional. replacement. necessary as'"the result of this work.•
Signature of Applicant or Agent .
Santis, �Wda Trails; LLC, 1003 Traske Rd., Encinitas, CA 92024 (760) 250-0793
Name.of Applicant (please print). Business Address Telephone No.
Raul for �Rent� 6�400 'Visher Rd., Riversides' CA 97507 (909) 8'53�2191
Name of Coniractor'and Job Foreman, Business Address Telephone No.
102975 04-036+ .
Contractor's License No. City Business License No.
Americ Intoruational RA2b71867
Applicant's Insurance Company Policy Number.
FEES: . Subdivision Improvement Permit =Class 111
Public improvements: 3% of estimated •constructi osts
Private'improvements: 3% of estimated ciinstrucl n ost�E� 2 2' 2003
'-Minor.lmproverrient Permit — Class IV: See attache c edulUeCl�4'j/Q .
No �+`Y
Inspection Fee $ 0+00 C TY OF LA QUiNTA
FINANCE DEPT. PERMIT VALIDATION
Permit Fee 100.00
PERMIT N0. 4044
Penalty 0.00
DATE APPROVED 12/16/03
Cash Deposit -Surety Bond
if required 0•00 EXPIRATION DATE®� ( Z /I ?
TOTAL: $ 100.00 '
DATE ISSUED I•. �)+� ��' �'
Receipt No. .�i ��,� - r�s..,.t ,.;, •.0 w� .- �t
By
Received by Date Administrative Authority
Recorded by Telephone:,(760) 777-7075
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date: December 11 , 2003
Location of Construction: �j a�-h �- iha�.SD.. Anr4c_j, 'I- 30y8`1
Purpose of Construction:e,M
Description of Construction: jevk- 4
Dimension of Installation or' Removal: 1(700 Gr
Approximate Construction Start Date: I a —1-) — 03
Approximate Construction Completion Date: I :k-101- 03
Estimated Construction Cost: $. f 2 ,100.00
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back -filling, compaction and
placing permanent resurfacing and or replacing improvements
Name of Applicant: Santa Rosa Tra i 1 s , LLC
Applicant Address: 1 603Traske Road, Enc i n i tas, , CA 92024 .
Applicant Telephone Number: 760-250-0793.
Name of Contractor: Rain for Rent - -
Contractor Address: 6400 Fisher Road, Riverside, CA 92507
Contractor Telephone Number: 909-653-2171
Contractor State License Number: 102975
Contractor City Business License. Number: 04036 (City of La Qu i nta )
ApX'licant or Contractor General Liability Insurance Company:
Applicant or Contractor General Liability Insurance Policy Number:.
Office Use Only:
Inspection Fee:
ny
(� 03
Permit Fee:
loo�1�
As -Built
Deposit:
q—
Dust Control
Deposit:
Credit
Amount:
TOTAL FEE DUE:
100.0
Office Use Only:
Assigned Permit Number:
Approval Date:
Expiration
Date:
Issue
Date:
Administrative Authority
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