CIP2016-0007W 4 .4 , See below for Finance Revenue Codes
OF
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.
DATE: 12/8/2016
LOCATION OF CONSTRUCTION(Street address or Description): MOON RIVER DRIVE N OF AVE 50
PURPOSE OF CONSTRUCTION: LANDSCAPING AND IRRIGATION
DESCRIPTION OF CONSTRUCTION: 2014-01C YMCA BUILDING TURF CONVERSION
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: 12/9/2016 TIME OF COMPLETION: 2/13/2017
ESTIMATED CONSTRUCTION COST: S86.000.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction 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 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
to pay for any additional replacement necessary as the result of this work. _--::; _-
Agent
KIRKPATRICK LANDSCAPING SERVICES
INC - LARRY LAYTON 43752 JACKSON STREET INDlO, CA 92201 (760)347-6926
Name of Applicant (please print) Business Address Telephone No.
KIRKPATRICK LANDSCAPING SERVICES
INC 43752 JACKSON STREET INDlO, CA 92201 (760)347-6926
Name of Contractor and Job Foreman Business Address Telephone No.
503360
Contractor's License No.
DEPOSITORS INSURANCE COMPANY
Applicant's Insurance Company
Finance Revenue Code
TOTAL: $0.00
632
City Business License No.
ACP3017908982
Policy Number
PERMIT NO: C1P2016-0007
DATE ISSUED: L! 1
EXPIRATION DATE: 'z/s I,,
W,OK INSPECTED BY*:
PERMIT COMPLETION DATE*: -
*If the work Is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
1 Tity 4 64~ a9mro
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date:
Tract No: ProjectName: rf1
Vicinity: y,4-
Purpose of Construction Qe.: Rough Grading, Mite Street, etc.)_________________
Description of Construction (i.e.: See Plan SetNo. 01234) /\J (
-
Dimension of Installation or Removal:
Approximate Construction Start Date:
Approximate Construction Completion Date: - 17
Estimated Construction Cost: $ 0 OD • C
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:.L#w L€+ov- Phone Number: 79 -
Name of App1icant/Ower: '-ftIZ.. LLc 't
Applicant Address: - 74 kcoi-, + TJ04- 5P
Applicant Telephone Number:
Applicant E-mail Address: ki . (Z k15 (vtC, Pie t
Name of Contractor: <; IrniA ' 'c#4
Contractor Address: L .114e r4 9
Contractor Telephone Number: -7 ( ('_-_-f_7_
Contractor State License Number: 5_, 3'
Contractor City Business License Number:
Contractor E-mail Address: __-_(s
10- A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED 4
Applicant or Contractor General Liability Insurance Company:
Applicant or Contractor General Liability Insurance
OfficeUseOnly:
Inspection Fee:
Permit Fee:
As-Built
Deposit:
Dust Control
Deposit:
Credit
Amount:
OfficeUseOnly:
Assigned Permit Number:C I P 20 I&- O
Approval Date:
Expiration
Date:
Issue
Date:
Administrative Authority:
TOTAL FEE DUE:
- harms 6, Appltcattô1AppIication