TC2016-0068See below for Finance Revenue Codes
Z
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: 9/15/2016
LOCATION OF CONSTRUCTION(Street address or Description): VIA SEVILLA EAST OF WASHINGTON ST
PURPOSE OF CONSTRUCTION: TURF REMOVAL / LANDSCAPE IMPROVEMENTS
DESCRIPTION OF CONSTRUCTION: CIP 2016-03A NORTH LA QUINTA PARKWAY TURF CONVERSION DEL ORO
DIMENSION OF INSTALLATION OR REMOVAL: SEE APPROVED PLANS
TE TIME WHEN WORK WILL BEGIN: 9/19/2016 TIME OF COMPLETION: 10/31/2016
ESTIMATED CONSTRUCTION COST: S153.000.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction
and placing permanent resurfacing and/or replacing improvements)
- - -
COMMENTS: (SEE PROJECT CONTRACT A NDSPECIFICATIONS FOR CIP 2016:03A 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 City of and
to pay foe any additional replacement necessary as the result of this work. /
of Apiflnt or Agent
URBAN HABITAT ENVIRONMENTAL
LANDSCAPES 00 BOX 1177 LA QUINTA, CA 92247 (760)296-3603
Name of Applicant (please print) Business Address Telephone No.
URBAN HABITAT ENVIRONMENTAL
LANDSCAPES P0 BOX 1177 LA QUINTA, CA 92247 (760)296-3603
Name of Contractor and Job Foreman Business Address Telephone No.
963744 LIC-0004501
Contractor's License No. City Business License No.
TRUCK INSURANCE EXCHANGE 60477-75-72
Applicant's Insurance Company Policy Number
Finance Revenue Code
TOTAL: $0.00
PERMIT NO: TC2016-0068
DATE ISSUED:90
EXPlRAJN DATE:
5. BY:
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: tii'IL V
Tract No: Of Z01 (rO3A Project Name: N IJMtI XV(SJG' T'.W t(W
Vicinity:
TUPVOT
of Construction (i.e.: Rough Grading, Offsite Street, etc.)________________
ft1wa k i .OiiidSQ Qen-S
Description of Construction (i.e.: See Plan Set No. 01234) c0
Dimension of Installation or Removal:
Approximate Construction Start Date: _________________
Approximate Construction CompletionDate: 4) NflC O4.jS
Estimated Construction Cost: $ 153, 000
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: OY1flVC t1UV Phone Number:
Name of Applicant/Owner: Cl4 C& .W U'cCt
Applicant Address: CiIk' 'glmpl(!o, Wi (iulA,
Applicant Telephone Number:
Applicant E-mail Address:
-
Name of Contractor:
Contractor Address: }O VZX I 1TI
Contractor Telephone Number: 1(0)
Contractor State License Number: 1(D
Contractor City Business License Number:
Contractor E-mail Address:
'A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED 4
Applicant or Contractor General Liability Insurance Company:
tvryry
Applicant or Contractor General Liability Insurance Policy Number:
Office Use Only:
Inspection Fee:
Permit Fee:
As-Built
Deposit:
Dust Control
Deposit:
Credit
Amount:
TOTAL FEE DUE: co
I In :nA,IICTC - I-nrmQ K. AflhIrTIflI
Office Use Only:
Assigned Permit NumberR LO I —Oo &&
Approval Date:
Expiration
Date:
Issue
Date:
Administrative Authority: