CIP2019-0007a& Q9&r(V
See below for Finance Revenue Codes
-GEM ofheDESERT---
CIP
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: 9/10/2020
LOCATION OF CONSTRUCTION (Street address or Description): DUNE PALMS ROAD
PURPOSE OF CONSTRUCTION:
DESCRIPTION OF CONSTRUCTION: 2009-04 DUNE PALMS ROAD WIDENING
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: TIME OF COMPLETION:
ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS:
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 4)
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
JACOBSSON ENGINEERING
CONSTRUCTION INC
Name of Applicant (please print)
JACOBSSON ENGINEERING
CONSTRUCTION INC
P 0 BOX 14430 PALM DESERT, CA 92260 (760)345-8700
Business Address • Telephone No.
P 0 BOX 14430 PALM DESERT, CA 92260 (760)345-8700
Name of Contractor and Job Foreman Business Address
650389
Contractor's License No.
WESCO INSURANCE COMPANY
Applicant's Insurance Company
Finance Revenue Code
TOTAL: $0.00
Telephone No.
City Business License No.
WPP121926904
Policy Number
PERMIT NO: C1P2019-0007
DATE ISSUED: 6/4/2019
EXPIRATION DATE: 12 /1/2019
BY: CARLEYESCARREGA
WORK 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.