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492e.�. .. •. .. r • _ T • � �. ♦ ^' .. � '•' ` � , • - - ' ate• •0 ! -.. • ,7 NOTE:- -With proper validation this form constitutes an •'. CITY OF LA OUINTA' x to `~ `., ... encroachment permit i 1 =+' APPLICATION FOR PERMIT L , . 04 '- _ � • ' ti 'PUBLIC WORKS" CONSTRUCTION (ENCROACHMENT) • ••• w M ..� H -I' • OvEFc,i E ONE --TRIP- PERMIT + C� OF. x For 'the construction of 'public or private' curbs, driveways, pavements, sidevvalks, parking; lots, sewers,, water, mains . and other like public works improvements in connection with MINOR IMPROVEMENTS'and APPROVED SUBDIVISIONS • Subdivision Improvement -Permit =Class III December- 28 ' 1989. ' • DATE: o T Minor Improvement Permit Class IV' LOCATION OF CONSTRUCTION- 48th' Avenue, Washington — Fred Waring and Adams t - M • •ti it (Street address or Description of Location) ' t• t r ''� PURPOSE OF CONSTRUCTION }'Sketch (attach,construction plans if appropriate) ' a` •"" i' DESCRIPTION'.OF,CONSTRUCTION ` 'HAUL .ROUTE: FRED WAKING �'TO s ' WASHINGTON,-• 48th "Avenue •and, Returns ,DIMENSION OF INSTALLATION"OR'REMOVAL F33 �nranPi^ f.•; '� + r r' r. 15' 2't; hi-ah, i 13' 6°widn e, 9n' 1.�ey -Requires, Traffic• Control/2 'pilot `vehicles per California Vehicle ,t SIZE OF EXCAVATION; IF NEEDED Code: + '" Requires.'County permit APPROXIMATE TIME WHEN WORK WILL BEGIN j • °•`, 1APPROXIMATE,TIME OF COMPLETION ' �'% t • , -�;.. ESTIMATED CONSTRUCTION COST $ t (Including removal of all obstruction; materials, and debris, backfilling, com- i' • R ,s s r: � '. paction and'aplacing permanent resurfacing and/or replacing improvements), ' In, consideration of the-granting`of this permit, the applicant hereby agrees -to:.. 5• Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harm] ess,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 i nder.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. t ! Comply with,'all applicable.City Ord inances,.the terms and conditions`of the permit'andrall'applicable, rules and regulations'of the City}of •. La Quinta and to pay for any additional replacement necessary as the•result of this work.T f'r i Signature of ApplicaW;2402' t or s i Cal -Permits `Inc. PO Box 799 Sanbernardino, 800-344-1912- 4' Name of Applicant (please print) Business Address - Telephone'No. Name of Contractor and Job foreman Business Address Telephone No. _ .. •• .. � • .. � rr- ..psi `-Contractor's Lice.nse'No. City Business License N6. `? Farmers jIns� Group 600221517 .Applicant's lnsurarice Company • t - Policy Numb6r j i FEES: , Subdivision Improvement,Permit —Class III 00502 e2 i 0 0670 ' i 2' 28-85' • ,Public improvements: 3%of estimated construction costs io C:ASL� � Private improvements: 3/0 of estimated construction costs %i0 492, t , Minor Improvement Permit — Class IV: See attached schedule Inspection Fee PERMIT VALIDATION Permit Fee PERMIT NO. A09 t " "• Penalty . • 4 a ;16 �12/2.8/89' ` Cash Deposit -Surety Bond .` R DATE APPROVED ✓ if required v :3 j2,/2%90,' . �. EXPIRATION'DATE TOTAL: 0n r DATE ISSUED• Receipt No.r B •W - Received by Date ` �•'Adrninistrative Authority Recorded by TELEPHONE: (619) 564-2246 NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) OVEFt"Ti4E Ol`?E TRIP PIa M1 1IT 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: December 2E, 19�9 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 4$th Avenue, Washington — Fred V3arinq ante Adams (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL 63 scraper 15 ° 2" high, 13' 6 "wide . 9 0' lona SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 21/2/90 Sketch (attach construction plans if appropriate) HAUL ROUTE: FRE;D HARING TO 11ASHINGTON, 48th Avenue and Return Requires Traffic Control/2 pilot vehicles per California Vehicle Code Requires County permit I—, �`_s `. APPROXIMATE TIME OF COMPLETION s} 1,� 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. Signature of Applicant or Agent Cal Permits Inca PO i3or 799 5anbernard-no, CA 0-2402 1-800-344-1911 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 License No. Parmers Ins. Grouz) E00221517 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 $ Permit Fee 10 • 0 y Penalty Cash Deposit -Surety Bond if required TOTAL: $ �? Receipt No. Received by Date Recorded by 832 PERMIT VALIDATION PERMIT NO. A92 DATE APPROVED 12/20/39 EXPIRATION DATE 2/1'V90 DATE ISSUED 1" 2S /S9 By Administrative Authority TELEPHONE: (619) 564-2246 N ,. I NI 21EC �8 ! 89 14: g4 CAL PERMIT A Wi tAgel EXCHANGE 1 INTERIM CERTIFICATE AS TO EVIDENCE OF INSURANCE ' TWO IS NOT AN INSURANCI POLICY. THIS IS ONLY A VERIFICATION OF iNIURANCR. rt DOE6 NOT IN ANY WAY lLARM. 9XTIND OR ALUM TH11 ZOVIRAOE 010ViDW 0Y THI POLICIES Lis?§D EI&LOW!• NSMW C : Fie 5PLes iwc, TA %, c�� rro o WOO eY • Auto Ow a+opor s • o This Is 11p.cert6fy that policies for the above named Insured care in forte as follows: ye. .� � dot•• '•'- MT his loll to Cortllloa9e A® To widen of Ines shell; etiplr®' Oil�yt 'days from .r » '1922, unless cancelle4 prier to such date by written notice to the named insured, Cg�1�:RR+� . VAMM 4W b=ar err s.n"W v r Owned Scodily Injury parson ftirisd f ,000 soul occurpancsi Non -Owned Employer's Nan4wnership Property Otamaga .—.--r—r----� 000 saclt occur Itco ` Q . • Continent Liabilit Single Limit liability for Coverages t:hackisd 2 above $ ,Opp each murrsrsco Mac . ( clou9atTr bodily Injury �e...r..�m 'ON suchper+ o s' OwnersCantrtatyors 0 Iconlroatial 0 - ._....r..:�.—. �----� ,coo each oa-m ice annual p®aro ' � produs►a ®.. • E9aveators Property Damage S ',000 each eesur o" products and/or ® : annul owu�ra -- pro ISO** Completed ratiane � Single limit liability far Covoroges cinkW above to • � annual o$A 4orp . ,000 paoduab a t► e ,000 each vehicle i3 '00 each 6tcurrer" LJ13 W�It S1Gttt�tOP nC d es. O tb or Vrodvvfis Warranty, Written 1.80wof Promises, oser+en ream®nt, un ci pal Or nonc Agrieemenl; Sidetrack Agreement, Elevator or Escalator Mointenonce Agreement only, unless accompa ed h s ecific endorsement providins additional Contractual COVerc e, Q�knDad !»kw 6tripuan wB,rCd • ' OWNED ,YVAR, AMON, TYPE OF 1466lItDY, LOAD CAPACITV TENT MATION NUAR1116R Aura . COVERED tiNt Umbrellas liability 000 retained limit POLICY NVMUR r�aclt occurrenrre $ �®, aggregate If this Interim Certificate As To Evidence Of inwance is td be cancelled prior to the expiration date, We sh011 provide days advance notice In writing to whorrl this cartificate is issued, Canl9icata isausd to; �� sr .� 5 1� 60ort. 0MA L — Nam Aadras 17 a C 49 kL%s V, -57 F) t�v) 9A QUG 1'j-f 19 Itf � t=ouMorsigntid • N*t Applic to n� T&No*. 4 * e In Toros the opgragato also applies is ownaors and contfactors, prorecii.e• controcruat anther completed operatrons. RI -- --...� sQ• INSURED'S COPY