0152NOTE:
With.proper validation,
this form constitutes an
b CITY OF LA 'QUINTA t. e<c.
encroachment 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 other like public works improvements in connection `with�MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
� y
Subdivision Improvement Permit = Class III Q
October 9', 1985 {
DATE: x Minor Improvement Permit:.Class.IV' '
LOCATION'OF CONSTRUCTION Calle Ensenada r,
•�'
(Street address or Description of Location)k
#
PURPOSE OF CONSTRUCTION NMI& Penmrmefit Paving Sketch (attach construction plans if appropriate)
j
Repair for over Gas Can;D ny work. {
DESCRIPTION OF CONSTRUCTION -'
• DIMENSION OF INSTALLATION OR REMOVAL''.
SIZE OF EXCAVATION, IF NEEDED '
APPROXIMATE TIME WHEN WORK WILL BEGIN 10-9-85
.APPROXIMATE TIME OF COMPLETION An-10—R5
ESTIMATED CONSTRUCTION COST $ 200.00' . t
(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'authorizecl 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. " , ,
n•
(r "
Signature of Avplica�t or Agent
S�nair Paying Inc. 68-369 �S�iriair .Read Cathedral' Ci CA 92234_ 324-6565
g tY
Name of Applicant (please print),_ ' Business Address Telephone'No. "
Dario Ouintero n n
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 I II
Public improvements: 3% of estimated construction costs
.Private improvements: 3% of estimated construction costs
- N101 152
Minor Improvement Permit Class IV: See attached schedule r
Inspection Fee $, 10.00 PERMIT VALIDATION I
Permit Fee 6.00= ����
"
PERMIT NO.
Penalty
Cash Deposit-Surety Bond ,. DATE APPROVED
Y
if required EXPIRATION DATE i n — 8�5�
r TOTAL: $ 16.00 R`5
+ DATE.ISSU.ED
Receipt No. (
F
t
By M� I �l A a .l tJ '
Received by, Date: Administrative Authority
Recorded'by• TELEPHONE: (619) 564-2246
r
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS, CONSTRUCTION (ENCROACHMENT)
i
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
October 9, 1985
LOCATION OF CONSTRUCTION 611e EnSer�da
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION YMMM Per7eruf-nt
R.e,;eir for over Gas Ccmf :'y17 work:
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV ;
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME WHEN WORK WILL BEGIN 10-9-85
- 6 � NTEREt1 DEC 1 01985 -
APPROXIMATE TIME OF COMPLETION 1 Q-1 f11-85
ESTIMATED "CONSTRUCTION COST $ _00.00
(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.
. .l ,
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.
j
Signature of pli t or Agent
Siziais Paving Inc. 68-369 Pinair_P08d_ -r- CathecTra1 City, CA 92234 324-6565
Name of Applicant (please print) Business Address r' Telephone No.
Dario C)uintero
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business.L'icense No.
Applicant's Insurance Company Policy Number
r
FEES: Subdivision Improvement Permit — Class I I I �EuUV F
Public improvements: 3% of estimated construction costs ' r
Private improvements: 3% of estimated construction costs
f, pis 152
Minor Improvement Permit "— Class IV,'. , 'a:ttached schedule
Inspection'Fee $ 10.00 PERMIT VALIDATION
Permit Fee 6.00= PERMIT N0:
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 16.00
Receipt.No.
Received by Date
Recorded by
DATE APPROVED
EXPIRATION DATE 1 O ` 30
DATE ISSUED 1 Q
BY
Administrative Authority;..
TELEPHONE: (619) 5642246 ` .
M U L J 1'U 7_----
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lion