0151With proper validation
thi.5-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: October 7, 1985 Minor_ Improvement Permit Class IV
LOCATION OF CONSTRUCTION Sagebrush Ave. and Washinat:nn Street
(Street address or Description of Location)
PURPOSE -OF CONSTRUCTION 1,7ater� Main Installation Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Construct 12" water main
connection across TXTas.hdrAto;n St. at SGaehrush. Ave .
DIMENSION OF INSTALLATION OR REMOVAL
4' x .400' trench n
SIZE OF EXCAVATION, IF NEEDED (�
5 �a
APPROXIMATE TIME WHEN WORK WILL BEGIN 10-7-85 (�� �t<<,c�110k _c c11-1 25APPROXIMATE TIME OF COMPLETI N
O
ESTIMATED CONSTRUCTION COST $ -c
(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:
f 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 peisons 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
Coachella �7alley Water_ Di._ft.rict _ p.o: Fiox 1058 C'oae hella, C.1.- 92236 398--265.1
Name of Applicant (please print) Business Address Telephone No.
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 ENTERU No
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 P2�,
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
. Recorded by
TAT I& 151
PERMIT VALIDATION
PERMIT NO. 151
DATE APPROVED 1.0-4-85
EXPIRATION DATE 12KIRM,llrl5-05 .
DATE ISSVED 10-7. $15
BY !, l.•l . ... s t t i i
Administrative Authority
TELEPHONE: (619) 564-2246
r
NOTE:
With proper validation
this form constitutes an
encroachment permit CITY OF, LA QUINTA
APPLICATION FOR PERMIT 4
PUBLIC WORKS -CONSTRUCTION (ENCROACHMENT)'
CE+� OF.
----_ ----- — — - - -' — ---- —
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
oe Subdivision Improvement Permit — Class III'
DATE: /►� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S�GCaR f!l/Y /�� %rf . �/✓/� q/�I �i/��j7�011/ Q7x4
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION AW44 701K M*1) LA7*46AVOW Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONPTRUCTION STitVG� ��
s+- W4r ti r�I
DIME 'SIO": CF !NS' L _ATION O REMOVAL
4�TRrE�G�d
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
QM�
APPROXIMATE TIME OF COMPLETION
C�
ESTIMATED CONSTRUCTION COST $ zs Ooe
(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 prooertN
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 o!
La Quinta and to pay for any additional replacement necessary as the result of this work. (Nor tr. 5
• 1�' a h dl'i
Signature of Applicant.or Agent
0 ISM 10<9,coA;Ntt- A �z a36 39'd -2 Gs'/
Name of Applicant (please.print) Business Address Telephone No.
Name of Contractor and Job Foreman Business. Address Telephone No.
Contractor's License No. City Business License No:
Applicant's.lnsurance Company Policy Number
NOTE
With`pro�r validation 4 2'
this form•constitutes an O
CITY ,OF LA QUINTA -
{'
encrt%c' ment permit : -
APPLICATION FOR- PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OF
For the construction of public or..private curbs, driveways,' pavements, sidewalks, parking lots,'sewers, water mains-
and
ains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit _ Class II I
DATE: October 7, 1985 Minor Improvement Permit Class IV .
LOCATION OF CONSTRUCTION Sacrebrush Ave. and Wash=crton Street r
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Water. Main InstallationSketch"(attach`construction lans if a • ',
p ppropriate),
DESCRIPTION OF CONSTRUCTION Construct 12" water train ,
connection across Washinifir'tora St. at Saaebrush Ave. `
DIMENSI.ON OF INSTALLATION ,OR REMOVAL
41 -x 400'-,trench
`SIZE OF EXCAVATION, IF NEEDED • e'• "
'.10-7-85 ,.
APPROXIMATE TIME WHEN WORK WILL BEGIN `
`APPROXIMATE TIME OF COMPLETION 11-1-85
ESTIMATED CONSTRUCTION COST $ -25;000.00 Tr _
(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 auth'orized'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 whenwork 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'.res`u'lt of this work. . 1r
/�i
Signature of Applicant or Agent
Coachella Valley Water District P.O. Box 1058 Coae hella, CA 92236 398-"2651
'Name of Applicant (please print) Business Address Telephone No.
Name of Contractor`and Job Foreman Business Address Telephone No. A
Contractor's License No. 'City Business License No.' j l
Applicant's Insurance Company Policy'Number `
FEES: Subdivision Improvement Permit — Class I I I
�- z Public`improvements: 3% of estimated construction costs
' Private improvements: 3% of estimated construction costs
Minor-Improvement Permit —Class IV: See attached schedule ,
. -
inspection, $ PERMIT VALDATON
Permit Fee Nva PERMIT NO. A 151.
Penaltyt. r.
Cash Deposit-Surety Bond
' DATE APPROVED 10-4-85 {
if required ;EXPIRATION DATE 11-15-85
TOTAL: $ -10-7=85
�.,. DATE ISSUED
• Receipt No. t x V
gy l i n
Received by Date vAdministrative Authority
V
Recorded by s TELLPHONE: (619) 564-2246 -
NINE:
With proper validation
--------------
this form constitutes 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
Subdivision Improveme-nt Permit —Class III
DATE:_ Minor Improvement Permit Class IV •
LOCATION OF CONSTRUCTION SAGCaRylH � �/� A%��yTo � e7r_g el
(Street address or Description of Location) ` -r
PURPOSE OF CONSTRUCTION �i✓A i� 107*► -ArlOdSketch (attach construction Plans if appropriate)
DESCRIPTION OF CONSTRUCTI
ri
DIMEI}ISION' CF !NS'. 1 ATION Of�tt REMOVAL
4 X � 4OG � TRrEn�Gf!
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 pr,00erty.
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 ot.
La Quinta and to pay for any additional replacement necessary as the result of this work. ncaf`R'�S
Signature of Applicant or Agent
-; 4`1.iii .A47sA Da7x1 C /os$, 40A&0f L4A 92- Z3 6 _19"t-2 er/ ,
Name of Applicant (please print) Business AddressTelephone No -
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
i
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