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0379NOTE: • ` 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 II I DATE: March 2, 1888 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION South West corner of Washington Street and Hwy 111 (Street address or Description of Location) To improve cjrainage at p ppropriate) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if a intersection. DESCRIPTION OF CONSTRUCTION Instali storm drain See the approved It plans on file. conduit and pump station. All 1 d't-' d 1 DIMENSION OF -INSTALLATION OR REMOVAL specia con a: .ions an genera conditions contained within the specifications for Washington Street Stormwater Pumping Station -- (Plaza. La Qth�inta) Project No 88-4. SIZE OF EXCAVATION, IF NEEDED shall apply to this. encroachment APPROXIMATE TIME WHEN WORK WILL BEGIN 3/1/89permit, No. 379: The Contractor shall all comply with APPROXIMATE TIME OF COMPLETION the special conditions contained ESTIMATED CONSTRUCTION COST $ within the attached, City Engineer (Including removal of all obstruction, materials, and debris, backfilling, com- approved, Constrxl tion schedule. - paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit, the applicant hereby agrees to:. - Indemnify, -defend o: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 thee 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 J & S Paving P.O. BOX74, Palm Springs, Ca. 325-2680 Name of Applicant (please print) Business Address Telephone No. Same, Chuck Janich Same Same Name of Contractor and Job Foreman Business Address Telephone No. 11.9707 Contractor's License No. Employers Insurance of Wausau 1350 City Business License No. 202900055016 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 Minor Improvement Permit — Class IV: See attached schedule,' 379 ' f Inspection Fee $ NA Permit Fee NA Penalty Cash Deposit -Surety Bond if required TOTAL: $ —� Receipt No. Received'by Date i Recorded by PERMIT VALIDATION PERMIT NO. 379. DATE APPROVED __ 312/89 EXPIRATION DATE __ 6/1/89 DATE ISSUED /3/2/89 / Administrative Authority TELEPHONE: (619) 564-2246 4 l�. lt,• I{ i lD "- J�.. ;f11..1'-. LJ.. J' -Il1 t0' ;..?., G ajr'1✓r r! .fi ruliJ�l- `J'. 1J _„(, •I,,. �, I. _ .• � - U11i: �i14 1�,r �i� .i ,.�?, r � ?,, ♦ ' - •l. 7 ` I /'t R� fit. t• .tJ, ., . �� , C A � J� NOTE: t. • ' `.f � �, •' ' .+ With proper validation •- F' this form constitutes an •~ CITY -OF: LA •QUINTA encroachment permit APPLICATION -FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) c� '`�•: tiSw4�, . ; y • • `SOF 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: March 2, 1989 - 'Minor Improvement Permit Class•IV, _ LOCATION OF CONSTRUCTION South .West .corner:. of ;Washington Street,: and' Hwy 111 (Street address or Description of Location) ' To. improve.*drainage' at . ` PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) , intersection. Insta storm drain. See the. approved plans•on;file. DESCRIPTIQN OF CQNSTRUCTION+ • •• • r conduit and pump-station. All. 'special conditions .and general. ~DIMENSION OF INSTALLATION,OR REMOVAL-' "cond,itions.%contained within the s.pecificatioris' for • Washington Street Stormwater Pumping,Station. ` (P.laza La Quinta). Project No 88-4. SIZE OF EXCAVATION, IF NEEDED 3 shall, 'apply. to chis` encroachment' ' permit; No'. •379. • ` APPROXIMATE TIME WHEN WORK WILL BEGIN 3/6/89 4/6/89 Y The Contractor. shall comply with' APPROXIMATE TIME OF COMPLETION the; special' conditions contained`I ESTIMATED CONSTRUCTION COST $' within.f.the'attached, City Engineer (Including,removal of•all obstruction: materials, and debris, backfilling, com approved, Construction schedule. paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting, of this permit, the applicant hereby agrees to- Indemnify, -defend o: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 under4the 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 ermit and all applicable, rules and regulations of the City of, S La Quinta and to pay for any additional replacement necessary 'as the res f this work: '•Signature of Applicant or Ag J & -S' Paving , _ • P..O...• BOX74,. ,Palm-;° Springs:,,. Ca. ;. •32.5-2680 r" Name of Applicant (please print)' 4 j# Business Address Telephone No. Same, Chuck Jaiich. Same: Same Name of Contractor and Job Foreman �3 Business..Address 4 „ Telephone No:• , 119702 i 1350` Contractor's License No. City Business License No. .Empioyers.Insurance.'of Wausau ., 202900055016 ` 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 1 9 ` Minor Improvement Permit — Class IV: See attached schedule ss Inspection.Fee $' NA ; ;,' - PERMIT VALIDATION Permit Fee NA v • ' ... PERMIT NO., 379 Penalty Cash Deposit Surety Bond DATE•APPROVED 3 / 2 / 8 9 if required- TOTAL: :$ -0- r Receipt No. Received-by Date { Recorded by i EXPIRATION'DATE 6/1/89 DATE ISSUED 3/2/89 By r Administrative Authority -TELEPHONE: (619) 564-2246• 1 '., NOTE: 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 Improvement Permit — Class II I DATE:— Minor Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION-�ou�1� (A)Qs-y-_ l A515,n.z*,5n Sy`- Ict (Street address or Description of Location) PURPOSE OF CONSTRUCTION IS AdidiMM ' m%na-AcCCA- Sketch (attach construction plans if appropriate) in�r.f['e�f�., See -.the. approved plans on file. DESCRIPTION OF CONSTRUCTION �,7 s;,6 ,,, Drag, Corolv,'f A1171 spec:Lal conditions and •General DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN �?AA'9 condition's contained within the Specifications for Washington Street Stormwater Pumping Station (Plaze La Quinta) Project No.88-4 shall apply -to this -encroachment permit, No. 379. The Contractor shall comply with the special condition's contained within the attached, City Engineer' APPROXIMATE TIME OF COMPLETION Approved, Construction Schedule. 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. Signature of Applicant or Agent Name of Applicant (please print) Business Address Telephone No.- rY1e k cf.1n �S-o. e M e Name of Contractdr and Job Foreman Business Address Telephone No. Contractor's License No.. City Business License No. Applicant's insLWance Company Policy Number FEES: 54.6 f ivision Imprr+vement 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 $ Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. $ Received by Date N° PERMIT VALIDATION PERMIT N0. s DATE APPROVED�� EXPIRATION DATE_T�� DATE ISSUED By Administrative Authority Recorded by . 11 TELEPHONE: (619) 564-2246 N -TI-f s 0'A IR olf- A cc T JLMM . 1171