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5169A. Finance Revenue Code E-1 ENCROACHMENT PERMIT PUBLIC WORKS CONSTRUCTION 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 Minor Improvement Permit Class IV DATE:September 29, 2006 LOCATION OF CONSTRUCTION (Street address or Description): Laguna de la Paz 20052; Eis Mhower west of Washington PURPOSE OF CONSTRUCTION: Remove eucalyptus tree with a lane closure KEisenhower Drive DESCRIPTION OF CONSTRUCTION: Remove eucalyptus tree DIMENSION OFINSTALLATION OR REMOVAL: 25 foot radius; 80 feet tall APPROXIMATE TIME WHEN WORK WILL BEGIN:WiII Call TIME OF COMP TIO :One day from start ESTIMATED CONSTRUCTION COST: $500.00 (Including rem val of all obstru do aterials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) COMMENTS: In consideration of the granting of this permit, the applicant hereby ag ee to: Indemnify, defend and save the City, its authorized age ts, officer represent ives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims r court action nd ari ing out of any accident, loss or damage to persons or property happening or occurring as a proximate result o any work undZadvnce rider the permit granted pursuant to this application. Notify the Administrative Authority at least twenty-four (24) hours in of the time when work will be started at (760) 777- 7075. Comply with all applicable City Ordinanc s, the t d conditions rmit and all applicable rules and regulations of the City of La Quinta and to pay for any additionq�l reply emen� nec sary as thf this work. Laguna de la Paz HOA - Jan Name of Applicant (please print) Desert Concepts Land & Maint. Name of Contractor and Job Fo tractor's License No. Hartford Insurance Applicant's Insurance Company 48300 Vista del Nop, Business Address FEES: Subdivision Improvement Permit - Class\11 Minor Improvement'Permit - Class IV \ Inspection Fee Permit Fee As -Built Deposit Cash Deposit -Surety, Bond, if required TOTAL $100.00 $ $ IiLrIrX111111] Address Signature of Applicant or Agent i Quinta, CA 92253 (760) 564-8864 Fax 564-8867 Telephone No. e Ste. D Palm Desert, CA (760) 200-9007 272-0398 . Telephone No. 6902 City Business License No. 72UUNSR3826 Policy Number Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs See attached schedule PERMIT NO.5 1 69 DATE APPROVED: EXPIRATION DATE:_ BY: Administrative Authority cN J- Tract No: o 2- Project Name: Vicinity: Pr Gt/esl Purpose Construction (i.e.: Rough Grading, Offsite Street, e c.) Descnpti of Construction (i.e.: See Plan Set No. 01234) ry loyC, alk) _'mac Dimension of Installation or Removal: Approximate Construction Start Date: O Approximate Construction Completion Date: 112jO& Estimated Construction Cost: $ ®,, Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back -filling; compaction and. placing permanent resurfacing and or replacing improvements Contact Name: T A Phone Number: 7C, Q -66 �143 4 Name ofApplicant/Owner: L0,14 /n,q (a 2 - A. Applicant Address: 4{,?3 o �V 1 s� d / W 0 j2 Q , (a Quli Ae , -45 Applicant Telephone Number: %6 o S-(o Applicant E-mail Address: Name of Contractor: 0a'OD'r-f- Contractor Address: "7-7---J "2 Q C, Contractor Telephone Number: Contractor State License Number:._ Contractor City Business License Number: Contractor E-mail Address: Applicant or " Company: 4 Applicant or Contractor General Liability Insurance Policy Number: �2 U t) ) 3 92,6 Office. Use Only: Office Use Only: Inspection Fee: Assigned Permit Number. S� Permit Fee: el Approval Date: As -Built Expiration Deposit: Date: Dust Control Issue Deposit: Date: Credit Amount: Administrative Authority: -Tc P z�a TOTAL FEE DUE: / ,D 0 I I Mministrative Services Division\Forms\APPLICATION FOR PERM1T.docc -SFrnN A^ RDrw CERTIFICA E OF LIABILITY INSURIANCE 01/03/06DmvY> PRODUCER HRH of Coachella Valley Insurance Services LIC #0511289 77-564 Country Club Dr., #401 Palm Desert, CA 92211 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Desert Concepts Landscaping & Maint 41-800 Washington St. B105, #112 Bermuda Dunes, CA 92201-0000 INSURERA: Hartford Insurance Group 29424 INSURER8: INSURERC: INSURER D: INSURERE: CY PERIOD INDICATED. NOTWITHSTANDING -HIS CERTIFICATE MAY BE ISSUED OR , EXCLUSIONS AND CONDITIONS OF SUCH JN LIMITS EACH OCCURRENCE $1 000 000 DAMAGE TO RENTED PR SUM, n $3OO OOO MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $1 00O 000 GENERALAGGREGATE s2,000,000 PRODUCTS - COMP/OP AGG s2,000,000 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG S S EACH OCCURRENCE S AGGREGATE $ S S S WC STATU- OTH- I E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT S USED POLICIES BE CANCELLED BEFORE THE EXPIRATION tER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN ER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL TY OF ANY KIND UPON THE INSURER, ITS AGENTS OR IIIJ ( i l__i� �`v✓ 21MAR © ACORDj=RPORATION 1988 :IVED JAN 0 7 2006