0147jt� NOTE;,
With proper validation, , Q•
this form constitutes an
CITY. OF LA -QUINTA
encroachment permit
APPLICATION FOR • PERMIT,-
PUBLIC-WORKS
ERMITPUBLIC.WORKS CONSTRUCTION` (ENCROACHMENT)
�- OOzp
For the construction of public or-private curbs, driveways, pavements; sidewalks, parking lots, sewers, water, mains r�
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVEDSUBDIVISIONS •}•
Subdivision Improvement Permit — Class I II
DATE: 8-19-85Minor Improvement Permit Class"IV X "
'LOCATION OF.CONSTRUCTION' NQrthwPSt COrner — Washin;rton St and Eisenhower Drive.
(Street addressor Description of Location)
PURPOSE OF CONSTfiUCTION Install and maintain sewer r '
- F
Sketch (attach construction plans if appropriate)
lift station within public riight.of way.
DESCRIPTION OF.CONSTRUCTION
DIMENSION OF INSTALLATION.OR REMOVAL
•i: 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
om paction and placing permanent resurfacing and/or replacing improvements) Y
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
, S .
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or propert .'� l•
happening or occurring as a proximate result of any work ungertaken under•the permit granted pursuant to this application., and t e
cont. _i
existence of this improvement"v ithin the public —of—way.,
Noti y 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.
Si4nature of Applicant or Agent
M.B. Johnson Construction. C,o. 74-140 El Paseo, .Shite # 3 619-346-0109
Name of Applicant (please print) Business Address Telephone No.,,'
Same Same, `'*Palm Desert 92260 ,
_ Name of Contractor and Job.Foreman Business Qdd'ress s Telephone No.
` . On' File On File j'.
Contractor's License No.,
`4 � , � City Business.License No.'
On File
Applicant's Insurance Company Policy Number'.
R
'FEES: Subdivision Improvement Permit — Class III-
Public
11Public improvements: 3% of estimated construction costs ;
Private improvements: 3% of estimated construction costs ; x
Minor-Improvement Permit — Class,IV: See attached schedule .. f l _ 147 y
Inspection Fee $ -PERMIT VALIDATION,E
Permit Fee 20.00
► ,, PERMIT NO."147
Penalty, • `
` Cash Deposit-Surety Bond 'DATE APPROVED •'8-19-85$
if required r ,�
EXPIRATION DATE NZA� 1 j
-TOTAL: $ 20„00 t " s
R DATE ISSUED
Receipt No.
By
Received by Date , Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
•
OTE:
With proper validation
this form constitutes an
encroachment permit
T
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 III
DATE: 5-19"35 Minor Improvement Permit Class IV x
LOCATION OF CONSTRUCTION Northwest Corner — Wasrd.n= t. 'and Eisenhower Drive. ..
(Street address or Description of Location)
PYIRPOSE OF CONSTRUCTION Install and-rkiintain.sewer Sketch (attach construction plans if appropriate)
lift . stata.on within pi -111 right of way.
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
ENTERED DEC
SIZE OF EXCAVATION, IF NEEDED
0MM°
APPROXIMATE TIME WHEN WORK WILL BEGIN -' WDUft1U�� CITED
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 unoertalfen under the pgrmit grantgd purs ant to this application. and te
con .J_r�uea istent,e of.. tris �: np:rwove� ient( ili.thin the . puh is ricf t -o -vTa
oti y the Administrative Authority at least't enty-four 24 hours in advance of the time when work winbe 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.
Si nature of Applicant or Agent
P":L.. 7oh son Cor.�straction Co. 74-140 El Paseo, Suite # 3 6.19-346-0109
Name of Applicant (please print) Business Address Telephone No.
Same Pa]srt E- alert 92260
Name'of Contractor and Job Foreman Business Address Telephone No.
On :E'i.1e On File
,Contractor's License No. City Business License No.
a.1 Pile
Applicant's Insurance Company Policy Number
FEES: "Subdivision Improvement Permit = Class III ENTEREC] NOV..Z. 5 1985
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 20.0:
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 20.60
Receipt No.
Received by Date
Recorded by
147
PERMIT VALIDATION
PERMIT NO. 147
DATE APPROVED 5-19-55
EXPIRATION DATE NIA
DATE TSS
416 1
Administrative Authority
TELEPHONE: (619) 564-2246
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