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CIP2019-0009tev Qa See below for Finance Revenue Codes —GEMofsIwDESERT-- - 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: 7/1/2019 -. LOCATION OF CONSTRUCTION(Street address or Description): SE CORNER OF DUNE PALMS &WESTWARD HO PURPOSE OF CONSTRUCTION: USE HOUSING AUTHORITY LOT FOR LAY DOWN YARD DESCRIPTION OF CONSTRUCTION: FOR C1P2019-0004 DUNE PALMS ROAD WIDENING; USE HA LOT DIMENSION OF INSTALLATION OR REMOVAL: APPROXIMATE TIME WHEN WORK WILL BEGIN: 7/1/2019 TIME OF COMPLETION: 11/15/2019 ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) COMMENTS: SEE PROJECTCONTRACT-AND SPECIFICATIONS FOR CIP 2009-04 FOR PERMIT CONDITIONS; WHEN PROJECT IS c—STA BILIZE -THE LOT AS REQUIRED BY THE CITY-ENGINEER 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. I~L Signature f Applican or Agent JACOBSSON ENGINEERING CONSTRUCTION - FRANK KIFER P 0 BOX 14430 PALM DESERT, CA 92255 Name of Applicant (please print) Business Address JACOBSSON ENGINEERING CONST P 0 BOX 14430 PALM DESERT, CA 92255 Name of Contractor and Job Foreman Business Address (760)404-8538 Telephone No. (760)345-8700 Telephone No. 650389 LIC-0003026 Contractor's License No. City Business License No. WESCO INSURANCE COMPANY WPP121926904 Applicant's Insurance Company Policy Number Finance Revenue Code TOTAL: $0.00 PERMIT NO: C1P2019-0009 DATE ISSUED: EXPIRAT , JON DATE: BY:-71 WOd'K 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. T4Af 4 4 a9 mr6i 1: PUBLIC WORKS DEPARTMENT APPLICATION FOR PERMIT Date: 7/1/19 Tract No Project Name 2009-04 Dune Palms Road Widening Vicinity: Dune Palms Rd between Whitewater Channel & Westward Ho Dr. Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.)_________________ Road Improvements (Housing Authority Lot) Description of Construction (i.e.: See Plan Set No. 01234) 2009-07 Dimension of Installation or Removal: See Contract Drawings Approximate Construction Start Date: 6/10/19 Approximate Construction Completion Date: 11/15/19 Estimated Construction Cost: $1,101,753.20 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: Frank Kifer Phone Number: 760-404-8538 Name of Applicant/Owner: Jacobsson Engineering Construction. Inc. Applicant Address: P. 0. Box 14430 Palm Desert, CA 92255 Applicant Telephone Number: 760-345-8700 Applicant E-mail Address: fkifer@jacobssoninc.com Name of Contractor: Jacobsson Engineering Construction, Inc. Contractor Address: P. 0. Box 14430 Palm Desert, CA 92255 Contractor Telephone Number: 760-345-8700 Contractor State License Number: 650389 Contractor City Business License Number: 0003026 Contractor E-mail Address: stacey©jacobssoninc.com 'A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED '4 Applicant or Contractor General Liability Insurance Company: Wesco Insurance Company - Greenwich Insurance Company Applicant or Contractor General Liability Insurance Policy Number: WPP121926904 - NEC600543800 Office Use Only: Office Use Only: Inspection Foe: Assigned Permit Number Cg Plo I', Permit Fee: As-Built Deposit: Dust Control Deposit: Credit Amount: TOTAL FEE DUE: 4-0 Approval Date: Expiration Date: Issue Date: Administrative Authority: 'JCO3SSOfl ENGINEERING CONSTRUCTION, INC. City of La Quinta 78495 Ca lie Tampico La Quinta, CA 92253 Attn: Leonard R. St. Sauver, Manager/Inspection Supervisor Subject: Housing Authority Lot for Lay Down Yard City of La Quinta, Dune Palms Road Widening City Project No 2009-04 Dear Leonard, June 6, 2019 In reference to the above subject matter, Jacobsson Engineering requests permission to use the Housing Authority Lot as a lay down yard for the above referenced project. The lot is located at the southeast corner of Westward Ho and Dune Palms. If you have any further questions or concerns, please contact the undersigned or Stacey Yamamoto at your earliest convenience. Thank you for your time, and we look forward to working with you. Jacobsson Engineering Inc. Frank KiMr Project Manager/ Estimator P0 Box 1443b Palm Desert, CA 92255-4430 0:060) 345-8700 F. (160) 345-8199 1 0• 1 -7 -