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0590J:.,a. • 4t' .f7. .r,K r•- rkt� '.Y 'YF }'.t ti 4 r•., ri '3 4.,� .M �,j".• .i�+�' t��FSb'=.6E�i�-...-�'��Syw�- ...'.'r�'i:'�,'�li.hr3ij..-ly;•�y- a'V�i-"- ,r4.r� "",�•;-�:..'^(a+p.a.+. ,-�,:r:, `-��' {� '�Y_.� kyi,,xilf,.K ..�.�'"'•ey. -ice ' �.r.w.•iK;a+:.t4Y!M^V+'ww..a. �:..•�•..�-y...,w r . �. .. .. r.ww r..w.-Y-r.. r=.w�-�....i. w. v.r •r�-+i'Shr r�w� r .r �.r.r .�. .w. �...� � .w �. w r NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) `'•fpr , r•` , For the construction ofublic or p 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: !'/ / ZZ 99kO LOCATION OF CONSTRUCTION (street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION.OF CONSTR.U�HION - DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Subdivision Improvement Permit — Class II I ,Minor I�pro�vement Permit Class IV Sketch (attach construction plans if appropriate) so" APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ QOSii�z W 3E49 (4-19-90 14 (Including removal of all obstruction, materials, and debris, backfilling, com- i0 I: SH i l OTAL i i0.00 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. • .---�-•- e 1. �.�-:y-- ure ot�Aoolicant or Name of Applicant (plea;6 print) �/ Business Address Telephone No. 1 / 6 Name of Contractor and Job Foreman Business Address Telephone No. Contractor's Vicense No. City Busines License No. 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 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° 0590 PERMIT VALIDATION PERMIT NO. �- DATE APPROVED _ EXPIRATION DATE, DATE ISSUED _ G / By _ G Recorded by 11 TELEPHONE: (61 Administrative Authority M!l�rt\ �_ #M. �<�a�'t�V"'�.r.C��l •(wt"!�K'T�!'N �� In i11^ M Y �. w r.� W v M 'r. •fi M YI .il� �i i W IP Yr M w w w W � �Y V W �ir�Y. M � r � w W � �� i W M ww M a1i `Fr IF 6 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 DATE: LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Subdivision Improvement Permit — Class II I inor Improvement Permit Class IV Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLA ION OR REMOVAL 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: il�D i1SSW i �ITAL iii—'JCS 10J161 1 4 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. Name of Applicant (plea3d? print) ure o%Applicant or Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. Contractor's Vicense No. City BusinesAicense No. 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 0590 Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ PERMIT VALIDATION Permit Fee PERMIT NO. Penalty Cash Deposit -Surety Bond if required DATE APPROVED T, EXPIRATION DATE��.�/�� TOTAL: $ DATE ISSUED Receipt No. �, 'By�:'� Received by Date r �j Administrative Authority Recorded by TELEPHONE: (619)r564�2246 NOTE: . With proper validation this form, constitutes an 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:lmprovement Permit - Class III ` DATE: Minor Improvement. Permit Class IV LOCATION OF CONSTRUCTION '(Street address or Description of Location) y - PURPOSE OF CONSTRUCTION Sketch (attach'construction'plans if appropriate) DESCRIPTION OF CONSTRUCTION�%� DIMENSION OF INSTALLATION OR REMOVAL` r Q��/5�� . SIZE OF EXCAVATION, IF NEEDED 1 �' APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME F 1 • • C•MRLET •N ESTIMATED CONSTRUCTION COST $ (Incl6dina.ren-iovai of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or s 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 andarising 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; jhe terms and conditions of the permit end 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.., Y ' Signature o pplicant or Agdnit Name of Ap nt (please print) Business Address Telephone No. `Name of•Contractor and Job Foreman Business Address Telephone No. < Contractor' icense No. f .' City Business L' i nse" No. Applicantnsurance Company Policy ^Number FEES: Subdivision I mprovement, Permit — Class .III Public improvements: 3%of,estimated construction costs .*A Private improvements: 3% of estimated"construction costs ' N0 w Minor Improvement Permit — Class IV: See.a6ached schedule Inspection Fee $ k ' ,PERMIT VALIDATION Permit Fee ' 'PERMIT NO. Penalty Cash Deposit -Surety Bond DATE APPROVED, ` if required EXPIRATION DATE TOTAL: $ DATE ISSUED• Receipt No.. ., r.. T By . Received by Date Administrative Authority }. Recorded by 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) - 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 OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION t� DIMENSION OF INSTALLATION OR REMOVAL _rte , SIZE -OF EXCAVATION, IF NEEDED ee APPROXIMATE TIME WHEN WORK W BEGIN —� APPROXIMATE TIME OF COMPLET ON — 1Cd�T ESTIMATED CONSTRUCTION COST mat (Includinc removal of all obstruction, ackfilling, com paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this. permit, the applicant, hereby agrees'.io: 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 o, pplicant or ent Name of Name of Contractor and Job Foreman Business Address Telephone No. Contractor's Lic se No. City Busin License No. i .e Applicant's Irvfurance.Company r ,_ Policy Number FEES: Subdivision Improvement 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 NOO Inspection Fee' $ Permit Fee 4 Penalty Cash Deposit -Surety Bond if required TOTAL: $ Receipt No. Received by Date Recorded by PERMIT.. VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE: (619) 564-2246