0068NOTE:
Vith proper validation
this form zAstitutes an CITY OF LA QUINTA
encroachment permit
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
Decmmber 14, 1984 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Jefferson St. Between Vista Grande and Westward Ho Drive
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Install f 2000' of
12" CML/CMC Domestic water oioe line
with appurtenances. Ste attached district dwawing
DIMENSION OF INSTALLATION OR REMOVAL Numbers 9326 & 9327
SIZE OF EXCAVATION, IF NEEDED 4' x 4'
APPROXIMATE TIME WHEN WORK WILL BEGIN Week of Dec. 17, 84
APPROXIMATE TIME OF COMPLETION Jan. 85
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.
Jim Zimmerman
Signature of Applicant or Agent
Cmachella Valley Water Dist. P.O. Box 1058 Coachella 398-2651
Name of Applicant (please print) Business Address Telephone No.
District Forces Same
Name 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® X68
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
No Fee
Date
PERMIT VALIDATION
PERMIT NO. N/a
DATE APPROVED Decmmber 14, 1984
EXPIRATION DATE June 14, 1985
DATE ISSUED - De
c
ember 114—,--1984
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE!'
With proper 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
t Subdivision Improvement Permit — Class I I I
DATE:. t Z I �a' `"C Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION CSC- 50 )-J S `� �i.V El ----"—J V L S n
q.\ VF..
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION INST 01L-416_
DIMENSION OF lNST:,LI_ATION OR REMOVAL
Sketch (attach construction plans if appropriate)
Itis
SIZE OF EXCAVATION, IF NEEDED '4 I -A 4 t Nu�f3��S
APPROXIMATE TIME WH N WORK WILL BEGIN (A)G
EI—E—ts%
mom.. �
APPROXIMATE TIME OF COMPLETION _ J Pc -1-J S
ESTIMATED CONSTRUCTION COST S
(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 I)ranted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the -time when work will be started.
i
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City o!
La Quinta and to pay for any additional replacement necessary as the result of this work.
S� All—
Signature of Applicant or Agent
\) A-L.LC----( U)AA-E&e I S11- l� U Otic 10 58 C6Alke- 1 +Ef_LA 3 S_8 266S ►_
Name of Applicant (please print) Business Address Telephone No. —
�Jl SA"^ C_
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company Policy Number
z