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4271NOTE: With proper validation this form constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) r 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: 11-10-2004 50 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Avenue X S/S W/O Rancho Santa Catalina (Street address or Description of Location) PURPOSE OF CON TRUCTION Access to Mauho DESCRIPTION OF ONSTRUCTION Access in , of Manhole. Lane C osiire e.�ui e DIMENSION OF INSIrALLATION OR REMOVAL SIZE OF EXCAVATI(DN, IF NEEDED APPROXIMATE TIMIJ WHEN WORK WILD BEGI Will call in advance tolappr APPROXIMATE TIM ESTIMATED CONST (Including removal of paction and placing I In consideration of tl Indemnify, defend, penalties, liabilities happening or occur Notify the Adminis Comply with all ap La Quinta and to r OF COMPLETIO JCTION COST $ II obstruction, m manent resurfac granting of this d save the City, r loss resulting E pi cabie o Be De::err, ne to of kart d to eking days Applicable terials 1. and debris, backfilling, om- ig an /or replacing improve m nts) perm , the applicant hereby agrees •1 g as a proxima a result t tive Authority at least pl able City Or finances, ay for any ad tional rep Sketch (attach construction plans if appropriate) orized agents, officers, re resentati sand employe ims or court action and rising out of any accider of any work undertaken under the permit granted enty-four (24) hours advance f the time wh e terms and conditi s of the pe mit and all ap� 3 ment necessary a the result of his work. harmless from and again any and all loss or damage to pers ns or property irsuant to this applic ion. work will be starte . able rules and re ations'of the City of \ / Signature of Applicant or Agent ,;. Louis Becerra, AKA Verizon Telephone Company 295 N. se Way, PS 778-3621 Name of Applicant (please print) Business Address Telephone No. Arizone Pipeline 65105 Dillon Road, North Palm Springs, CA Name of Contractor and Job ForeR9423'5`15 xBusiness Address Telephone No. A 6849 Contractor's. License No. City Business License No. Brown and Brown Insurance Company of Nevada ALP70636704 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 ►. :r. 11 11 Penalty Cash Deposit -Surety Bond if required TOTAL: $ 100.00 Receipt No. Received by Date W 4271 PERMIT VALIDATION PERMIT NO. — 4971 DATE APPROVED 11-17-2004 EXPIRATION DATE 11-17-2005 DAT SS D By Administrative Authority Recorded by - 11 Telephone: (760) 777-7075 v 'r NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit , APPLICATION FOR PERMIT -t' PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) •i 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: 11-10-2004 5� Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Avenue S/S W/O Rancho Santa Catalina (Street address or Description of Location) PURPOSE OF CONSITRUCTION Access to Manho Sketch (attach construction plans if I p appropriate) DESCRIPION TION ss14 oSxT iianhole Lane Closure pequiTed 1�0 Not pplica fAL ple DIMENSION OF INSTALLATION OR REMOZ SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TI.MEjWHEN WORK WILI,/BEGI �o be veterm+ned WiIY ca�Ll in advance to appr a of start dote APPROXIMATE TIME OF COMPLETION C wbrxing days ) ESTIMATED CONSTR- CTION COST $ of Applicable N (Including removal of alll obstruction, ma erials,/and debris, backfilling, Lom- paction and placing pe manent resurfacing and/or replacing improvem nts) In consideration of the granting of this permiyt, the applicant hereby agrees f Indemnify, defend, a d save the City, its authorized agents, officers, representatives and employee , harmless from and against any and all penalties, liabilities ,r loss resulting fro cl�ims or court action and /under arising out of any accideni, loss or damage to persg�is or property happening or occurribg as a proxima a result of any work undertaken the permit granted pursuant to this applicakiaon. Notify the Administrative Authority at least enty-four (24) hours�n advance jof the time when work will be star�at/ins Comply with all apple able City Or`inances, t e terms and conditions of the permit and all applicable rules and i of the City of La Quinta and to pay for any ad tional replacement necessary as/the result of `Y this work. / Signature of Applicant or Agent J. Louis Becerra, AKA Verizon Telephone Company 295 N. Sun se Way, PS 778-3621 Name of Applicant (please print) Business Address Telephone No. Arizone Pipeline 65105 Dillon Road, North Palm Springs, CA Name of Contractor and Job Foreman Business Address Telephone No. Clfl/CY3 t;gfs" ""` v�fS 4 735i 6849 Contractor's License No. I City Business License No. Brown and Brown Insurance Company of Nevada ALE70636704 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 $ Not Applicable Permit Fee 100.00 Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by Recorded by $ 100.00 Date 4271 PERMIT VALIDATION PERMIT NO. 4971 11-17-2004 DATE APPROVED EXPIRATION DATE 11-17-2005 DATEII`SS,UE{�D By Administrative Authority Telephone: (760) 777-7075 NOTE: With popper validation 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 DATE: 11-10-2004 r :a Subdivision Improvement Permit — Class I I I Minor Improvement Permit Class IV Avenue T?O, S/S W/O Rancho Santa. Catalina LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSITRUCTION Accesel to Manho DESCRIPKdeassink0 of RHannlo0le. aana Closure i�eau rea DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROX.I ATE TIME WHEN WORK WIL BEGIi w�ii1 ca1Y 3n advance I appr a or start daite APPROXIMATE TIMEJOF COMPLETION/ z w r1K3,ng days i ESTIMATED CONSTRUCTION COST $ t+lo Applicable I(Including removal of II obstruction, materials, and debris, backfilling, com- paction and placing pe manent resurfacing and/or replacing improvem nts) In consideration of the. granting of this(permlit, the applicant hereby agree Sketch (attach construction plans if appropriate) A Indemnify, defend• a'hd save the City,,its auth1orized agents, officers, rep"resentatives and employee , harmless from and against any and all penalties, liabilities fr loss resulting from claims or court action and arising out of any acciden , loss or damage to pers ns or property happening or occurri�g as a proxima a result of any work undertaken if under the permit granted�ursuant to this application. Notify the Administr tive Authority at least ttenty-four (24) hours n advance of the time when work will be starte . . [. Comply with all applicable City O finances, the terms and conditions of the permit and all applicable rules and reg ations of the City of La Quinta and to pay or any add?tional replacement necessary as/the result of this work / Signature of Applicant or Agent J. Louis Becerra, AKA Verizon Telephone Company 295 N. Su se way, PS 778-3621 Name of Applicant (please print) Business Address Telephone No. Arizona Pipeline 65105 Dillon Road, Borth Palm Springs, CA Name of Contractor and Job Forema �, Business Address Telephone No. QWX344/eSfr� j 42. 6849 Contractor's License No. City Business License No. Brown and Brown Insurance: Company of Nevada AgE70636704 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 $ Not Applicable Permit Fee 100.00 Penalty Cash Deposit -Surety Bond if required TOTAL Receipt No. $ 100.00 Received by Date f - 4271 PERMIT VALIDATION PERMIT NO. 4271 11-17-2004 DATE APPROVED EXPIRATION DATE 11-17-2005 DATE ISSUED ) 1 /! ] / �' 1 x By Administrative Authority Recorded by Telephone: (760) 777-7075 i NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT a PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 5 a 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 DATE: LOCATION OF CONSTRUCTION Subdivision Improvement Permit — Class II I Minor Improvement Permit Class IV 5 ., — 7�,i4 _ ' be 51ic ... :1`'.- � (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION Sf 4 A' DIMENSION OF INSTALLATION OR REMOVAL Us CaL�,�`'G`"�o SIZE OF EXCAVATION, IF NEEDED l APPROXIMATE TIME ,WHEN,WORK WILL'BEGIN� Sketch (attach construction plans if appropriate) APPROXIMATE TIME;jOF COMPLETION ESTIMATED CONSTRUCTION COST $ r� ., (Including removal of a'II obstruction, materials land debris, backfilling, com- paction and placing pefmanent resurfacing and/or replacing improvements) c i In consideration of the�igranting of this'perm ' the applicant hereby agrees to: Indemnify, defend• and save the City, -its authiorizecl agents, officers, representatives and employe penalties, liabilities or loss resulting from claims or court action and arising outjof any accider happening or occurring as a proximate result ',,of any work undertaken under the`permit granted Notify the Administrative Authority8at least t1wenty-four (24) hours in advance 'of the time wh( r, t; , Comply with all applicable City Ordinances, the terms and conditions of the permit and all appl La Quinta and to pay�lfor any additional replacement necessary asfthe result of this work. r es, harmless from and against any and all aj, loss or damage to persons or property pursuant to this application. i en work will be started. icable rules and regulations of the City of Signature of Applicant or Agent Name of Applicant (please print) Business Address Telephone No. d l Name of Contractor and Job Foreman, Business Address Telephone No. 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 r, Cn(r TOTAL: Receipt No. Received by Date 6927t�, PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE 8�� DATE ISSUED By Administrative Authority Recorded by 11 Telephone: (760) 777-7075 ;e NOTE: With proper validation this form constitutes an encroachment permit q r ti CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) s 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 11--1Q-2004 Subdivision Improvement Permit — Class II I DATE: Minor Improvement Permit Class IV Avenue 90 VS W/O Baucho Sent* Catalina LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Accoas to harihole DESCRIPAcIO sling otT Xinft4. *. lAno Closuro Riquirod DIMENSION OF INSTALLATION OR REMOVAL Ito aipplaapl e A t SIZE OF EXCAVATION, IF NEEDED I Sketch (attach construction plans if appropriate) •h z � r ( T l i 1 APPROXIMATE TIME;WHEN WORK WILLfBEGIN jtic na usceMzeeea will C^Ii f in advance >�o�a�prot oY start afar* APPROXIMATE TIMEjOF COMPLETION 4 ► cvtt8 adys ESTIMATED CONSTRUCTION COST $ttC e9►pptcas�i+s (Including removal of all obstruction, materials,land debris, backfilling, com- paction and placing permanent resurfacing and%or replacing improvements) In consideration of the granting of thispermit, the applicant hereby agrees t'o: Indemnify, defend• and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all r 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 or any additional replacement necessary as the result of this work. La Quinta and to pay V 1 Signature of Applicant or Agent J. Louis Becorra-111 ABA Ala Tizon `>wolopl out Coupatty 295 X. Suax aea Wavy, PS 778-3621 Name of Applicant (please print) Business Address Telephone No. ArIt ane Ptpa Tina 65105 Dillon load, North Paella Springs„ CA Name of Contractor and Job Foreman Business Address C10/64/06-A— 4 ,r Contractor's License No. brown and brown Insur&nc a Compainy of Nevada Telephone No. 6849 City BusinAX 10636104 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 $ Not Applicable 1VU. V Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by 100.00 $ Date * 4211 PERMIT VALIDATION PERMIT NO. 4271 1V--17-2004 DATE APPROVED EXPIRATION DATE 11-17-2005 DATE ISSUED By Administrative Authority Recorded by 11 Telephone: (760) 777-7075 License Detail Pagel of 3 License Detail CALIFORNIA CONTRACTORS STATE LICEN: Contractor License # 423545 DISCLAIMER A license status check provides information taken from the CSLB license data base. Before on this information, you should be aware of the following limitations: • CSLB complaint disclosure is restricted by law (B&P 7124.6). If this entity is subject tc complaint disclosure, a link for complaint disclosure will appear below. Click on the lin button to obtain complaint and/or legal action information. • Per B&P 7071.17, only construction related civil judgments known to the CSLB are di: • Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration. • Due to workload, there may be relevant information that has not yet been entered ont Board's license data base. Extract Date: 11 /19/2004 * * * Business Information * * * ARIZONA PIPELINE COMPANY PO BOX 401865 HESPERIA, CA 92340 Business Phone Number: (760) 244-8212 Entity: Corporation Issue Date: 06/02/1982 Expire Date: 06/30/2006 * * * License Status * * * This license is current and active. All information below should be reviewed. * * * Classifications * * * ClassI Description C34 PIPELINE C36 PLUMBING C10 ELECTRICAL K�JJGENERAL- ENGINEERING CONTRACTOR * * * Certifications * * * http://www2.cslb.ca-gov/CSLB—LIBRARY/License+Detail.asp 11 /19/2004 License Detail Page 2 of 3 Cert I Description HAZ HAZARDOUS SUBSTANCES REMOVAL * * * Bonding Information * * * CONTRACTOR'S BOND: This license filed Contractor's Bond number 194961 C in the arr $10,000 with the bonding company INDEMNITY COMPANY OF CALIFORNIA. Effective Date: 01/01/2004 Contractor's Bonding Histoty BOND OF QUALIFYING INDIVIDUAL(1): This license filed Bond of Qualifying Individual i 194979C for RONALD CLIFFORD SYFRIG in the amount of $7,500 with the bonding cor DEVELOPERS SURETY AND INDEMNITY COMPANY. Effective Date: 12/29/2000 BQI's Bonding History BOND OF QUALIFYING INDIVIDUAL(2): The Responsible Managing Officer (RMO) LO DUANE MOYERS certified that he/she owns 10 percent or more of the voting stock/equit, corporation. A bond of qualifying individual is not required. Effective Date: 06/07/1982 BOND OF QUALIFYING INDIVIDUAL(3): This license filed Bond of Qualifying Individual i 194978C for THOMAS RAY SEARLS in the amount of $7,500 with the bonding comp; DEVELOPERS SURETY AND INDEMNITY COMPANY. Effective Date: 12/29/2000 BQI's Bonding History NOTE: There are 4 qualifiers (with bonding information) for this license. Up to 3 are d on this.page. * * * Workers. Compensation Information * * * This license has workers compensation insurance with the ST PAUL FIRE AND MARINE INSURANCE COMPANY Policy Number: WVK8300787 Effective Date: 04/01/2004 Expire Date: 04/01/2005 Workers Compensation History Personnel listed on this license (current or disassociated) are listed on other licer http://www2.cslb.ca.gov/CSLB_LIBRARY/License+Detail.asp 11 /19/2004