0135NOTE: •
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
Subdivision Improvement Permit — Class I I I
DATE: July II, 1985 Minor Improvement Permit Class IV x
LOCATION OF CONSTRUCTION soz;thwest corner of 7Rve_ 54 enc: Yciciison Street
P.G.A. West Fi:ce Station Site
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION rn nff .z�itFSketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Pavi,,rr r►mrl=and pif-tpr, Plans on _file.
*Nate: to ;�_ constructed.er
DIMENSION OF INSTALLATION OR REMOVAL cry. nc approved plans.
SIZE OF EXCAVATION, IF NEEDED �'-e Plans.
APPROXIMATE TIME WHEN WORK WILL BEGIN 7915_8=,
d
APPROXIMATE TIME OF COMPLETION' 1 C 85 986 ,
ESTIMATED CONSTRUCTION COST $ E.WEREU
(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 permi ..arid-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.
%%
10'x' CM��onnlicant o Agent r' - —
CA 92253•.;0 564-6446
Ic '_sand Co. P.O. Sox -1578 la 1
Name of Applicant (please print)
Business Address
Telephone No.
Name of Contractor and Job Foreman : Business Address Telephone.No.
O.F. 133 .
Contractor's License No. City Business, License No.
Home Ins. Co. GA1524892
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III C nt-�ERE� NOV
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
13
Minor Improvement Permit —.Class IV: See attached schedule
NT In, n
Inspection Fee $ waived I�
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ .111aiVE3
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 135
DATE APPROVED 7`8_85
EXPIRATION DATE 12 -30 -85 -
DATE ISSUED
.By
Administrative Authority.
TELEPHONE: (619) 564-2246 4 "
i
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�g AL3 � : �.
ifsyh\�•�,: � °iti3ii YE^r..,,���✓
i
NOTE: ,� •� _ r
' With proper validation Y OF �-
this.form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT - -"
+ PUBLIC WORKS CONSTRUCTION (ENCROACHMENT).��
' f 'SOF Tf1�9
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: July 8, 1985 Minor Improvement Permit Class IV X
LOCATION OF CONSTRUCTION 50uth�st corner of Ave. 54 and Madison Street
P.G:A. Westa Fire Station Site
. } (Street address or Description of Location) ,
PURPOSE OF.CONSTRUCTION .nn A Off Sif-F± imnrrxaWn11Mntc_ Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Pa�iincx_ 'r-»rli PnA isil"Ct r_ Plans on file:
etc,
ate to be constructed per
DIMENSION OF-INSTALLATION.OR.,,REMOVAL caro n1;4,"Q apprdered plans.
SIZE OF EXCAVATION,'IF NEEDED see plans.
APPROXIMATE TIME WHEN WORK'WILL BEGIN
APPROXIMATE TIME OF COMPLETION•- 10-1-85 r
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com . '
paction and placing permanent re surfacing,.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 I
penalties, liabilities,, or loss resulting from claims or.court action and arising out of any accident, loss or damage to persons or property y 11
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority atleasttwenty-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 permitand-allrules and regulations of the City of �1
` La Quinta and to pay for any additional ,replacement necessary as the result Work! .
Sig a urre/e��of Applicant or—Agent
Landmark Land cc). P.O. Box 1578 CA 92253564-6446
Name of Applicant (please print) Business Address Telephone No: j
same ..
r: Name of Contractor and Job Foreman Business Address Telephone No.
`O.F. 133
Contractor's License No. City Business License No. .
HCM his. Co. GA1524892
`.� 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 $ Waived • PERMIT VALIDATION
Permit Fee PERMIT NO. 135
Penalty 7-8-85 'I
4
DATE APPROVED
Cash Deposit -Surety Bond _
if required EXPIRATION DATE •12-30-85
Waived
TOTAL:. $
f DATE ISSUED
Receipt No. E `
By
Received byDate O / Administrative Authority
z
Recorded by TELEPHONE: (619) 564-2246 F '