4193A
1.
NOTE:
With proper validation
this form constitutes an
encroachment permit
f
CITY OF LA QUINTA
� I
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
July 15,
DATE: -July 2004 Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Puerta Raul, TM 30096,, 57-325 Madison Street
(Street address of Description of Location)
PURPOSE OF CONSTRUCTION On —site Paving Sketch (attach construction if a plans
On —Site Street Phase I & 11 P appropriate)
DESCRIPTION OF CONSTRUCTION
*See Attached Special Conditions*
DIMENSION OF INSTALLATION OR REMOVAL = 7i. JJO Sti�rt'
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 8/23 04
APPROXIMATE TIME OF COMPLETION 9/3/U4
ESTIMATED CONSTRUCTION COST $ Z 0• 1
(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 wheh'work- will -be started.
Comply with all applicable City Ordinances, the terms and conditions of -the permit and aloiapplicable rules and regu/l'a)tii
La Quints and to pay for any additional replacement necessary*the result of thisrk.�
ns of the City of
Signature of Applicanrbr Agent
Mark Alexander, 57-325 Madison Street, La Quinta, CA 92253 (760) 574-6518
Name of Applicant (please print) Business Address Telephone No.
GL Gayler Construction, Inc., P.O. Box 403, Thermal, CA 92274 (760) 774-5678
Name of Contractor and Job Foreman Business Address Telephone No.
A 524011
1232
Contractor's License No. City Business License No.
Coachella Valley Insurance Services c V,rk Zljf:I1., 39DCOL001277
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 $�
Permit Fee ll o o: O j
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ % J
4 Receipt No.
Received by' Date
Recorded by
EARED
4193
PERMIT VALIDATION
PERMIT NO. 4193 }
DATE APPROVED -7" L b - Q %-( '
EXPIRATION DATE �'1.7- E 11 05
DATE ISSUED
`�
Administrative Authority
Telephone: (760) 777-7075
f ��
07/27%2004 TUE''0'8 36 `FA%7.6�0:.777'•7155:,:,.. ':,,;.."'ClO, of'Ld.0Quinta` Pub':Wk ..,. r<.:;a.. ,_,,..,,,..:__.,..,., ♦..: �001;.•..:.•.,_.;.,�
t xcsc TX REPORT �k�k8c
TRANSMISSION OR
JOB -NO. 0637
DESTINATION ADDRESS 97771457
PSWD/SUBADDRESS
DESTINATION ID
ST. TIME 07/27 08:315
USAGE T 01'07
1 PCs. ' 3
RESULT OR »
CITY OF LA QUINT;.
PUBLIC WORKS:
DEPARTMENT
FACSIMILE TRANSMITTAL SKEET
O: MARK ALEXANDER RUERTA AZUL
AM 760-777-1457
TM: ' PERMIT FEES
ROM: DATE; TUESDAY, JULY 275
Anthony Co]amssi, 2004
Assistant Engineer I
Any questions, please call me.
Thanks, Tony
} V
CITY OF L-A, Q Uj N T A
O: MARK ALEXANDER ' PUERTA-AZUL > ,
FAX:. 760-777-1457
ITEM: PERMIT FEES
FROM: DATE: TUE SDAY, JULY.27,
Anthony Colaross4 2004
Assistant.Engineer I
t
t 1 — ---'--------— — — — — —r s -- —— —'- — — — — — —
--- ---
'NOTE: t
With proper validation
this form constitutes an CITY. OF LA' OUINTA
encroachment permit " S
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT). '" 64
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: -July 15, 2004 '. Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Puerta Azu1,'TM 30096, 57-325 Madison Street
(Street address or Description of Location) -
On -site Paving plans,appropriate)
PURPOSE OF CONSTRUCTION Sketch (attach construction if
On —site Street Phase I & II
DESCRIPTION OF CONSTRUCTION Road •Base Hot As It
*See Attached Special Conditions*
DIMENSION OF INSTALLATION OR REMOVAL-=7TtOJA sj, t"
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 8/23/04 ,
APPROXIMATE TIME OF COMPLETION 9/3/04
,ESTIMATED CONSTRUCTION COST $ I Z 0. 111, 0 a
(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.
Signature of Applicant or Agent
Mark Alexander, 57-325 Madison Street, La Quinta, CA 92253 (760) 574-6518 '
Name of Applicant (please print) Business Address Telephone No.
GL Gayler Construction, Inc., P.O. Box 403, Thermal, CA 92274 (760) 774-5678
Name of Contractor and Job Foreman Business Address Telephone No.
A 524011. f 1232
Contractor's License No. City Business License No.
Coachella Valley Insurance Services ,-jr VN 39DCGLOO1277
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
t
Minor. Improvement Permit — Class IV: See attached schedule W i 4193
Inspection Fee $ 3� 6O0 • O PERMIT VALIDATION
Permit Fee - too 0 J 4193
PERMIT N0.
Penalty
Cash Deposit -Surety Bond '
if required
TOTAL: $
Receipt No.
Received by Date
Recorded 6y '
DATE APPROVED 7-2-6-04
r
EXPIRATION DATE
DATE I S��J.A,.Iw`- % - Z
By t t
Administrative Authority
II.. Telephone: (760)
-7075
10