0012With proper validation
this form q',Xtitutes an
encroachment permit
E
0
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
t 23, 1983 Subdivision Improvement Permit— Class III
DATE: g Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION IA=tiOn 1: In Ave. 50, approx. 250 feet West of Avila Drive
:[,ovation 2: In Ave. 50 approx. 900 feet West of Avila Drive in SE k of Sec 31, T5, SR 7;E, Sgt
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION In8tall 1-12"X12" Tec and Sketch (attach constructionlans if appropriate)
ppropriate)
3-12" G.Vs at two locations set out move and
t)ESC.R°IPTI.ON=OF-CONSTR:U:CTI:ON: aPPurtres as shOWn on
attached CVGED drawings No. 10948 and No. 5-7-31-3
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
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.
Ernie G. Blevins, Right of Way Technician
Signature of Applicant or Agent
_Coachella Valley Water District, P.O. Box 1058, Coachella, CA 92236 (619) 398-2651
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
Contractor's License No
Business Address
Telephone 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 $ $30.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
—/ rn
Na
$ wn nn,
Date
NQ 112
PERMIT VALIDATION
PERMIT NO. Q
DATE APPROVED q-14— / 9 :
EXPIRATION DATE 'I " / y-' S`'�`
DATE I
SSUED +�
By
l Administrative Authority
TELEPHONE: (619) 564-2246
NOAY
With proper validation
this form constitutes an
encroachment permit
R E C E I tl' E
AU6 2 4 1983
CITY OF LA QUINTA City of La Quints
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
DATE:
LOCATIOfVr'OF CONSTRUCTION
(Street address or Description of Location) .tit
PURPOSE OF CONSTRUCTION+
DIMENSIO^: Cc=INST,',LLATION OR REMOVAL
SIZE
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
7'
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class tV
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 124) 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 Agentige�
eel ta C-4,eaL &&_ac C, ?6'1
Name of Applicant ( ease print) Business Address TelephonAIVo.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
4.
...I� •,�' j Ivy., �'-" -t, i4e
TRACT 87Y2---"41
..- °^ � �, � �\,a� , ! `;R,- / / � ".� e �9` /,1 ,� •�i eye` t '� "�
TRACT 4295 10 rb
27
If
")ANT N v ( \' e.yC
Pip
-� � � � '�" fin• n \7 / / ^O /T/ry j- % ;•.'�. �-�� \
271WELL
h
23 ems :rEf-
.. ^ ___`t',_- —• ¢ O X11! wili I P4 q. I�.
FIVE IN-�-Mfi.iW-N�NII-.►J1tNN IV -I -r1`- I rN
1 •�� — — -� �='""r..� 8:�����
AVENUE
o moi•= r� «— :�, 50
' � �a�/�"I�,.•X1G�� 1 ems' �. � � �
S- is G•J's � •'`-� ''
1
V
t '
1
- f