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4270+ NOTE: With proper validation t this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT i PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 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 Subdivision Improvement Permit — Class I II DATE:=1-10-2004 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTIONi F, D:,ert Club Drive E/S N/0 Aveu,.ida L4 F'onda (Street address or Description of Loca on) \ PURSE OF CONSTRUCTION1 Provide IAcce `to Manhole I Sketkh (attach con DESC TION ff CONSTRUC ION ecc ssi.nf via note, Lane osure Req ire d DIMENSION OF INSTALLATON OR RYMOVAL SIZE OF EXCAVATION, IF WEDED APPROXIQOATE TIME WHEI WO -J ? y Call wheul beL, APPROXIA ATE TIM/ea OMPL ESTIMAT CONSTON Cl (Including moval ofstruct paction an placing Went r In consider ion of tnting Indemn y, defensave th penaltie liabilitioss res happeni or occas a prNotify t e Admie Auth Comply ith all ble CitLa Quinta and toor any ILL BEGIN 10 iig work TION 2 'working a _ys ST $• ti A on, materials, and debris backfilli surfacing and/or replac' g impro, >f this permit, the ap icant her City, its authorized age ts, officers, Iting from claims or c rt action a ximate result of any ork undertak rity at least twenty- ur (24) hour Ordinances, the to s and conditi , itional replace ent necessary as ete , com- o �A z) al 1 e- Iby agrees to: plans if appropriate) representatives a d employees, harmless from d against any and all arising out of ny accident, loss or dam- to persons or property n under the per it granted pur/sand application. in advance of t e time when wtarted. s of the permi and all applicabgulations of the City of ie result of thi' work. Signature of Applicant or Agent J Loul Becerra. aka Verizon Telephore 295 North Sunrise Way 760-778-3621 Name of Applicant (please print) Business Address Telephone No. A-ri2:oyte Pipeline Company 65105 Dillon Road, North Palm SprJ_ngs, CA 92258 Name of Contractor and Job Foreman Business Address Telephone No. �y 3 L'10/04/C36 A 2 � J Not Applicable 6849 Contractor's License No. City Business License No. iJriLwri & Brovni insurance of Nevada ALP70636704 Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class 111 Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor. Improvement Permit — Class IV: See attached schedule A► 1 4270, Inspection Fee $ PERMIT VALIDATION 100.00 Permit Fee PERMIT NO. 4270 Penalty 1.1—'15-2004 Cash Deposit -Surety Bond DATE APPROVED if required EXPIRATION DATE 11-15-2005 TOTAL: $ 100.00 DATE I SU DI I Allo 11. _ Receipt No. - By. Received by Date Administrative Authority Recorded by 11 Telephone: (760) 777-7075 x NOTE: With proper validation' - �`" ihi"s foLrp constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT Lk PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) or 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 Subdivision Improvement Permit — Class II I DATE: 11-10-2004 Minor Improvement Permit Class IV Desert Club Drive E/S NO0 Avenida La Fonda LOCATION OF CONSTRUCTION, (Street address or Description of.Locatt'on) PURPOSE OF CONSTRUCTION Provide Acce to Manhole Sketch (attach construction plans if appropriate) I M r ecclssing lay o_Le, DESCR,IPTION OF CONSTRUCTION kLane f;Xre osul�eq fired DIMENSION OF INSTALLAT16N OR 4MOVAL r SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN`WORdWILL BEGIN jo isq veteiparned W411 Call wheni begi�{ining work N APPROXIMATE TIME OF 0' TION 2 working days ESTIMATED CONSTRUCTION COST $ N/A (Including removal of all obstruct'on, materials, and debris, backfilling, com- paction and placing permanent r surfacing and/or replacing improvements) In consideration of the granting of this permit, the applicant hereby agrees to: i Indemn y, defend and save the City, its authorized agents, officers, Irepresentatives and employees, harmless from and against any an`d all _. penaltie, , liabilities or loss resulting from claims or court action and arising out of any accident, loss or damag�t0 persons or property happeni g or occur ring as a prgximate result of any Work undertaken under the per it granted pursuant to this application. Notify the Administrative Authority at least twenty— our (24) hours in advance of the time when work will be started. Comply Vand pplicable City Ordinances, the teems and conditions of the permff applicable ru /s and regulations of the City of La Quintpay for any a ditional replacement necessary as Yh`e result of thT 't __ Signature of Applicant or Agent J. Lecerra aka Verizon Telephone 295 North Sunrise Way 760-778-3621 Name of Applicant (please print) Business Address Telephone No. Arizone Pipeline Coppany 65105 Dillon Road, North Palm Springs, CA 92258 Name of Contractor and Job Foreman Business Address Telephone No. C10/C34/C36 A c�jy��_ Not Applicable 6849 Contractor's License No. City Business License No. Brown & Brown Insurance of Nevada ALP70636704 Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ Permit Fee 100.00 Penalty Cash Deposit -Surety Bond if required TOTAL: $ 100.00 Receipt No. Received by Date j' Recorded by 4270 PERMIT VALIDATION 4Z/U PERMIT NO. DATE APPROVED 11-15-2004 EXPIRATION DATE 11-15-2005 DATE JS�SUJE�.D{ Administrative Authority Telephone: (760) 777-7075 NOTE: With proper validation��" this fo m constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) " 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 Subdivision Improvement Permit — Class I I I DATE: 11-10-2flfl4 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Desert Club Drive E/S N60 Avenida La Fonda �s (Street address or Description ofyLocaYon PURPOSE OF CONSTRUCTION ProvideAee to Manhole Sket1h (attach construction plans if appropriate) DESCRiI , TION OF CONSTRUCTION ecclssxng ria note. ane C1,98ure Rcq tsred DIMENSION OF INSTALLATION OR 136OVAL ! C SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN -WORK WILL BEGIN 1" WA11 Call wCten/begifirning work 2 working dhys APPROXIAATE TIME OF dOMPLETION t ESTIMATED CONSTRUCTION CAST $ N A (Including removal of all 09struction, materials, and debrisibackfilli g, com- paction and placing permaanent resurfacing and/or replacing improvements) In consideration of the g/anting of this permit, the appIiicant hereby agrees to: Indemni y, defend, and save the City, its authorized age .ts officers re resentatives a d em I I /nd "j� Yp p oyees, harm ess from�against any .and<all . penaltie?` liabilities � loss resulting�from claims or covert action arp arising out of Iny accident, loss or dama7 to persons or property happeni g or occurr7.ng as a pr-ximate result of any work undertaken under the per�it granted pursuant to t iss application. Notify t o Adminif' rative Auth rity at least twenty-f ur (24) hours in advance of the time when work wi/ll�be started. Comply with all applicable City, Ordinances, the terms and conditions of the permit and all applicable r Aees and regulations of the City of La QuintsVandtopay for any additional replace ent necessary as tle result of thiwork. 7 Signature of Applicant or Agent J. Lecerra aka Verizon Telephone 295 North Sunrise Way 760-778-3621 Name of Applicant (please print) Business Address Telephone No. Arizone Pipeline Coppany 65105 Dillon Road, North Palm Springs, CA 92258 Name of Contractor and Job Foreman _ Business Address Telephone No. C10/C34/C36 A 0, 6 1 9 Not Applicable 6849 Contractor's License No. City Business License No. Brown & Brown Insurance of Nevada ALP70636704 Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule �{ jl270 .� Inspection Fee $ PERMIT VALIDATION 100.00 rr Permit Fee PERMIT NO. Penalty 11-15-2004 Cash Deposit -Surety Bond DATE APPROVED if required EXPIRATION DATE 11-15-2005 TOTAL: $ 100.00 _ DATE ISSUED 4 Receipt No. gy �\r Received by Date Administrative Authority Recorded by Telephone: (760) 777-7075 NOTE: With proper validation- 4 this foam constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 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 Subdivision Improvement Permit — Class III DATE: 1i"1Q"��©� Minor Improvement Permit Class IV Donert Club Drive 6/S NOO Averaida La ronda LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION ovide Arc Prs to Manhole Sketch "(attach 'construction plans if a ppropriate) w Nt:oiazr�a.tt�; r��rriva.r�, ) DESCRjP,TI e C surrSaTKoq�i reed / DIMENSION OF INSTALLATION OR REIMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIIVI TE TI,ME WHEN WORK WILL BEGIN �`� +"* "``R'F"'``&WI *3ii� Ca Call wtien j begYpnxng work I I APPROXIMATE TIME OF COMPLETION 'r�.a `lb ESTIMATED CONSTRUCTION COST $ ) (Including removal of all obstruction, materials, and (Jebris; backfillirg, com- paction andl placing permanent resurfacing and/or replaciIng improvements) In consideration of the granting'k€tf this permit, the applicant her by agrees to: Indemnify, defend and' save the City, its authorized age ts, 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 damagerto persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. Notify thye Administrative Authority at least twenty-four (24) hours! in advance of thte time when work w,,i%ll�be started. Comply with all applicable City ordinances, the terrors and conditions of the permit and all applicable�rruAes and regulations of the City of La Quinta�and tolpay for any additional replacement necessary as the result of this! work. / Signature of Applicant or Agent J. LoUV Becarra aka Vorizon Telephone 295 North Sunrise Way 760-778-3621 Name of Applicant (please print) Business Address Telephone No. Arizont Pipeline Coppany 65105 Dillon !load, North Palm Springs, CA 92258 Name of Contractor and Job Foreman C10/C34/C36 A 11.-; 2 Contractor's License No. y Brown & Brown Insurance of Nevada Business Address Telephone No. Not Applicable 6849 City Business License No. ALP70636704 Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class 111 Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ 100.00 Permit Fee Penalty Cash Deposit -Surety Bond if required 100.00 TOTAL: $ Receipt No. Received by Date 4270 PERMIT VALIDATION w..rrr PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED 11-15-2004 11-15--2005 By Administrative Authority Recorded by Telephone: (760) 777-7075 NOTE: k Wif4roper validation this form constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 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 Subdivision Improvement Permit— Class III DATE: 11"'1�"��� Minor Improvement Permit Class IV deerxt Club Drivo S/S NOO Avenida La Vonda LOCATION OF CONSTRUCTION (Street address or Description of PURPOSE OF CONSTRUCTION Provide DESCRI,�AklbN coloWur* Room Nad Sketch (attach construction plans if appropriate) kt rid"ILIU.Lu. ! N i DIMENSION OF INSTALLATION OR REMOVAL 4 i � l 1 I r ! t SIZE OF EXCAVATION, IF NEEDED 1 ! APPROXIMATE TIME WHEN WORK *WILL BEGIN �� �'� �ra�raex�►x ►� will Cali utr,an. 'ouRiunink Work i APPROXIMATE TIME OF COMPLETION rr�rtcsa; nsyr ESTIMATED CONSTRUCTION COdST $ riJ (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replaci6g improvements) In consideration of the granting o f this permit, the applicant hereby agrees to: �Y 1 i 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 pr oximate result of any work undertaken under the perm it granted pursuant to this application. Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work MIA started. t 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. r� t Signature of Applicant or Agent J. Lout. Becearrot aka V'ax isOn Telsphons 295 North Sunrise Way 760-778-3621 Name of Applicant (please print) Business Address Telephone No. Axzxon* P%P*A itt* Coppany 65105 Dillon toad, k4orth Ps1% Springs, CA V4456 Name of Contractor and Job Foreman Business Address Telephone No. 00/04/06 A ,� ± ; Not Applicable 6849 Contractor's License No. City Business License No. bra 6 Brown 1Qaurance of Nevada AL!'6361%o Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class I I I Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. luuouv luu. u() Received by Date { 4270 PERMIT„VALIDATION PERMIT NO. 11-15--1004 DATE APPROVED EXPIRATION DATE 11-15--2005 DATE ISSUED By Administrative Authority Recorded by 11 Telephone: (760) 777-7075