00011.
NOT"1 r
With proper validation
this form constitutes an
encroachment permit
N
4*
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
April 25, 1983 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Thi-' is for a blanket P=dt for streets cut in La Qui.ta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION SeLViCe Of Made leets
DESCRIPTION OF CONSTRUCTION Wa#kaX leakS in Vc_XiOLis
locations
DIMENSION OF INSTALLATION OR REMOVAL Different sizes.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN W02:k baS beM
cximletpA.
APPROXIMATE TIME OF COMPLETION April 29, 1983
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Sketch (attach construction plans if appropriate)
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.
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 R. L. MCDCK%v 11"
Southern Calif mia Wiater. Cwipany, P. O. Bax 6, La Qu4r+ta (619) 564-2246
Name of Applicant (please print) Business Address Telephone No.
Cee Paving, 31976 Lindon Ladera, icucaip. (714) 794-2990
Name of Contractor and Job Foreman Business Address Telephone No.
A-105299
Contractor's License No. City Business License No.
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 ,P
L $ �`� � �` eAl2A4
Permit Fee ,G?'a�1A0i` -4Q
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
0
$ /,D�G'•GIG'�
Received by Date
`0�
PERMIT VALIDATION
PERMIT NO.�
DATE APPROVED
r �
EXPIRATION DATE
r �
DATE ISSUED
Byiti"�l
/ Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
—
With proper validation
this form constitutes an CITY OF, LA QUINTA
encroachment permit
APPLICATION FOR PERMIT - t F j •:
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
DATE:
.i — ?1!5* � —IS00.2
Subdivision Improvement Permit — Class III
Minor Improvers t Permit Class IV�
LOCATION OF, NSTRUC ION I t 1 'S cJ ^P'
(Street address or Description of Location) J
PURPOSE OF CONSTRUCTIONO
DESCRIPTION OF CONSTRUCTION 11JllA-(_- r
DIMENSION OF lf`.IST,-.L!_ATION OR REMOVAL.121 -t— A:cE ' Pr9d
5t22S
SIZE OF EXCAVATION, IF NEEDED
AW4k§IOXIMATE Tl*kWHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
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.
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.
�tt\\ ' +� Signature of Applicant or Agent /
Ot)t'Y�fi>C'N I /—Or'IV 1 O� W 1' G o 2. - dao, L•� e
Name of Applicant (please print) Business Address Telephone No.
C%eeI'zoKee ?,4v,wa.-3ig76. L„�do, i.o,-Aet^o,-Yuc:gAA— 1-71AI-?piAI-20)gQ
Npme of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APP,R•OVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authority