9011 (2)Tit4t - 4 4*Qumrw
ENCROACHMENT PERMIT
PUBLIC WORKS CONSTRUCTION
See below for Finance Revenue Codes
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:- 3/6/2009
LOCATION OF CONSTRUCTION: 7 Locations (See Attached List)
PURPOSE OF CONSTRUCTION:. CVWD Project
DESCRIPTION OF CONSTRUCTION: Need to Do Maintenance on Air Vac
DIMENSION OF INSTALLATION OR REMOVAL: N/A
APPROXIMATE TIME WHEN WORK WILL BEGIN: 5/9/2010
TIME OF COMPLETION: 5/13/2010
ESTIMATED CONSTRUCTION COST: N/A (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacingUMprovements)
COMMENTS City Will Invoice the Permittee for T&M Expenses TBD on Material Ledger.
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 occuring 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 at (760) 777-
7097. To submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at
least twenty-four (24) hours prior to the anticipated inspection.
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
Fred Amador - CVWD
PO Box 1058, Coachella, CA 92236
760-832-3918
Name of Applicant
Business Address
Telephone No
CVWD Forces
PO Box 1058, Coachella, CA 92236
760-832-3918
Name of Contractor and Job Foreman
Business Address
Telephone No.
N/A
$0.00
N/A
Contractor's License Number
City Business License No
Self -Insured
Self -Insured
Applicant's Insurance Company
Policy Number
FEES Subdivision Improvement Permit - Class I
-Minor Improvement Permit - Class I
I
Finance Revenue Code
Inspection Fee E_1
$0.00
Permit Fee E_1
0.00
As -Built Deposit E-A
0.00
Cash Deposit -Surety Bond, E_B
$0.00
if required
TOTAL
$0.00
Public Improvements: 3% of estimated construction costs
Private Improvements: 3% of estimated constru ction. costs
PERMIT NUMBER: ,RENEWED ..9011
DATE ISSUED: MaY S� r ze i0
EXPIRATION DATE_ /URA Z9. To i / ;P
BY:
WORK INSPECTED BY": &
PERMIT COMPLETION DATE": 47i -"i o
If the work is covered by a Subdivision Improvement Agreement, Subdivider .
shall request final acceptance of improvements from the City Council.