PG2015-00084 ,
See below for Finance Revenue Codes
ENCROACHMENT PERMIT
OF
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: 9/1/2015
LOCATION OF CONSTRUCTION (Street address or Description): 78-275 CALLE TAMPICO
PURPOSE OF CONSTRUCTION: LA QUINTA LIBRARY PARKING LOT AND LANDSCAPE IMPROVEMENTS
DESCRIPTION OF CONSTRUCTION: CIP 2014-13A LA QUINTA LIBRARY PARKING LOT IMPROV. & LANDSCA
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN:9/1/2015 TIME OF COMPLETION: 9/30/2015
ESTIMATED CONSTRUCTION C05T:S420.349.60 (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 PERMIT CONDITIONS
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 of and
to pay for any additional replacement necessary as the result of this work.
(O#Tl64U
Signature of Applicant or Agent
MIKE HONZ 2000 EXECUTIVE DRIVE PALM SPRINGS, CA 92262
Name of Applicant (please print)
GOLDEN VISTA CONSTRUCTION INC
DBA GOLDEN
Name of Contractor and Job Foreman Business Address
(760)250-8479
Telephone No.
(661)940-9914
Telephone No.
Business Address
44300 LOWTREE AVENUE STE 118 LANCASTER, CA 93534
776249
Contractor's License No.
BERKLEY ASSURANCE CO.
Applicant's Insurance Company
Finance Revenue Code
TOTAL: $0.00
LIC-0009964
City Business License No.
VU M B008 6690
Policy Number
PERMIT NO: PG2015-0008
DATE ISSUED: / c
EXPIRATION DATE:////('
BY: .5
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.
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date:
Tract No: Project Name: LI( .,çQr1 Pq L IlIo4tAu
Vicinity:1-fl5 Ct1',n V' 2DI(-/ —iA
Purpose of Construction (i.e.: Rough Grading, Mite Street, etc.)__________________
Description of Construction (i.e: See Plan Set No. 01234)
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Dimension of Installation or Removal:
I Approximate Construction Start Date: '\' I
Approximate Construction Completion Date: q .3 o 'I &
Estimated Construction Cost: $ M?.,
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:
Name of Applicant/Owner: _j
Applicant Address: ZOOO
Applicant Telephone Number:
Applicant E-mail Address:
Phone Number: ico ?5O %q 1
Name of Contractor: Cvlko \1o11 n1
Contractor Address: ZOOO Ec.t ij 4;g q. o Pak t-t.tj qatroa
Contractor Telephone Number: 1c0 Mt —no O
Contractor State License Number: I G p'ig
Contractor City Business License Number: O,p g
Contractor E-mail Address: t
A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED-4
Applicant or Contractor General Liability Insurance Company:
hc\t.j Co,
Applicant or Contractor General Liability Insurance Policy Number:
\JM 001U60
Office Use Only: Office Use Only:
Inspection Fee: Assigned Permit Number: F~, 2_01 OD
Permit Fee: Approval Date:
As-Built Expiration
Deposit: Date:___________________________________________
Dust Control Issue
Deposit: Date:
Credit
Amount:. Administrative Authority:
TOTAL FEE DUE:
I1rIu/( :nrkIIt — I-nrm N. r,r,IIr't,r,nc Ar,nIirtr,n ft-,r i-'rmit nrtii x..iF_riw
RECEIVED
CITY OF LA QUINTA
CALIFORNIA
2015 AUG 26 AM U 29
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