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0563/ A NOTE:•' With,proper=val idation this form constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION' (ENCROACHMENT) ONE TRIP OVERSIZE LOAD PERMIT 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 ♦ . c r i Subdivision Improvement Permit — Class II I DATE: April b,.+ 1990 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION ' MOVE EQUIPMENT (Street address or Description of Location) , PURPOSE OF CONSTRUCTION Sketch (attach construction plans if, appropriate) DESCRIPTION OF CONST RUCTION B, Npai-4 o+- x HAUL ROUTE: AVENIDA BERMUDAS TO ` AVE. 52 east to'WASHINGTON North on Washington to City Limits DIMENSION OF INSTALLATION OR REMOVAL �► MOVE ON:. •APRIL 9, 1990 SIZE,OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN i APPROXIMATE TIME OF'COMPLETION ESTIMATED CONSTRUCTION COST $ ' i(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 p rm a d all applicable rules and regulations of he City of La Quinta and to pay for any additional replacement necessary as the. result of this or ,. r fSign Lure of Applicant or Agent / . Name of Applicant (please print) Business Address (/ Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. on file nn If I y Contractor's License No. City Business, License No. ' on file Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit—Class III 105 i NSM F4rAL-16-90 �0..0 1 K , Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule �?° r 0563 Inspection Fee $ Permit Fee in nn tr Penalty Cash Deposit -Surety Bond if required TOTAL: $ 10.00 Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT N0. 0563 DATE APPROVED A.1 r, /an EXPIRATION DATE = 4/9/90 DATE ISSU,6_ / • 4/6/90 By Administrative Authority TELEPHONE: (619) 564-2246 NOTE: With proper validation this form constitutes an encroachment permit CITY' OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) ONE TRIP OVERSIZE LOAD PERMIT 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: April 6, 1990 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION ME)VE EQUIPMENT (Street addressor Description of Location) . PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTIONBr%Vis* n+^4 nAg-w- HAUL ROUTE: AVENIDA BERMUDAS TO ✓ AVE. 52 east to WASHINGTON North on Washington to City Limits DIMENSION OF INSTALLATION OR REMOVAL MOVE ON: 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: APRIL 9, 1990 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. i Comply with all applicable City Ordinances, the terms and. conditions of the permd 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, Name of Applicant (please print) Applicant or Agent' Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. on file on file Contractor's License No. City Business License No. on file Applicant's.l,nsurance Company Policy Number U 7g FEES: Subdivision Improvement Permit — Class III( %1(�"�11iU'TAL4^��rg 0,00 i© 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 10 - 00 Penalty Cash Deposit -Surety Bond if reouired TOTAL: $ Receipt No. _ 10.00 Received by Date Recorded by r PERMIT NO N2 .. 0563• PERMIT VALIDATION 0563 DATE APPROVED 4/6190 EXPIRATION DATE,. - 4/9/9`0 DATE ISSUED, �� 4/6/90 ;r By Administrative Authority TELEPHONE: (619) 564-2246 NOTE: With proper validation e 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 III DATE: .` Minor Improvement Permit Class IV ----------- LOCATION rLOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach'.construction plans if appropriate) DESCRIPTION OFCONSTR ICTION 0 DIMENSION OF INSTALLATION OR REMOVALy L41 SIZE OF EXCAVATION; IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN I APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of.all obstruction, materials, and debris, backiiiiing; 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 an plicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as the result of this ork. Sign ure of Applicant or Ageflt VV Name of App t (please print) Business Address Telephone No. s: ,Name of Contractor and Job Foremam Business Address Telephone No:'� Contractor's License No. City Business License No. Applicant's Insurance Company' r Policy Number FEES: Subdivision Improvement. Permit — Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs NO Minor Improvement Permit.— Class IV: See attached schedule j� Inspection Fee $ PERMIT VALIDATION Permit Fee .,PER NO. Penalty" DATE APPROVED Cash Deposit -Surety Bond if required EXPIRATION DATE TOTAL: $ DATE ISSUED Receipt No.. By Received by Date s Administrative Authority Recorded by TELEPHONE: (6191 564-2246 ' _� 3 J i l ' _� 3 i l ' _�