CIP2019-0015a& QaLfta See below for Finance Revenue Codes
-GEM oftheDESERT-
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 CONSTRUCTIO N (Street address or Description): 78060 FRANCIS HACK
PURPOSE OF CONSTRUCTION: REMOVE AND REPLACE EXISTING CONCRETE PAD
DESCRIPTION OF CONSTRUCTION: 2019-18 FRITZ BURNS POOL HEATER
DIMENSION OF INSTALLATION OR REMOVAL:8' X 157"
MATE TIME WHEN WORK WILL BEGIN: 12 /16/2019 TIME OF COMPLETION: 1/8/2020
ESTIMATED CONSTRUCTION COST: S183,815.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction and
placing permanent resurfacing and/or replacing improvements)
COMMENTS: SEE PROJECT CONTRACT AND SPECIFICATIONS FOR CIP 2019-18 FOR PERMIT CONDITIONS / SEPARATE BUILDING PERMITS REQUIRED FOR
HEATERS AND WAILS
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
WATERLINE TECHNOLOGIES, INC. 620 SANTIAGO ST. SANTA ANA, CA 92701
Name of Applicant (please print) Business Address
WATERLINE TECHNOLOGIES INC 620 N SANTIAGO ST SANTA ANA, CA 92701
Name of Contractor and Job Foreman Business Address
263844
(714)564-9100
Telephone No.
(714)564-9100
Telephone No.
Contractor's License No.
FEDERATED MUTUAL INSURANCE COMPANY
Applicant's Insurance Company
Finance Revenue Code
TOTAL: $0.00
City Business License No.
0623485
Policy Number
PERMIT NO: C1P2019-0015
DATE ISSUED: 12/11/2019
EXPIRATION DATE:6/8/2020
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.