0602t
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NOTE
With proper validation
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this form constitutes an CITY OF LA QUINTA
encroachment permit
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
4/27/90 Subdivision Improvement Permit — Class III•
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION, _ mclur F.6TTTAMFNT-
(Street address or Description of Location)
` PURPOSE OF CONSTRUCTION ' Sketch (attach, construct ion plans if appropriate)
DESCRIPTION OF ONSTRUCTIONwater trunk (tank (
10' wide, eight.and.we'g t ega HAUL ROUTE BERMUDAS.NO.RTH TO,
AVE. 52 east toJEFFERSON
DIMENSION OF INSTALLATION OR REMOVAL
HAUL DATE: April '27, 1990
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 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 Ouinta and to pay for any additional replacement necessary as the result of this work.
y
Signature oif pplicant or gent .
e -��n�"
and Rack PO Rn3r 17nnCA Ttlis A 927.01
Name of Applicant.(please print) Business Address Telephone No.
-Name of Contractor and Job Foreman Business Address _ Telephone No.
on ' file on file., J.
Contractor's License No. City Business License No.
r�
Applicant's Insurance Company Policy.Number
FEES: Subdivision. Improvement Permit — Class 111 00502Q4 -27-9U to
10 LASH i47..
(:l'T'HL S.. [ t? . Q0
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs � 0602
Minor Improvement Permit -Class IV: See attached schedule d�2 '
Inspection. Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:.
Receipt No.
Received by
Recorded by
$ 10.00
Date
PERMIT VALIDATION
PERMIT NO. (,.0602
DATE APPROVED A 127/9f
EXPIRATION DATE 4/27/90
DATE ISSU.4/27/90. ...
• E -D /
By- A� M
Administrative Authority
TELEPHONE: (619) 564-2246
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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
DATE: 4/27/90
LOCATION OF CONSTRUCTION' MOV -P PO TTTPMF'NT
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CON T1�tUCTiodweight
water trunk (tank (
le' wide, heighanwe g t legal HAUL ROUTE: BERMUDAS NORTH' TO
AVE. 52 east toJEFFERSON
DIMENSION OF INSTALLATION OR REMOVAL
HAUL.DATE: April 27, 1990
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 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 df—Applicantt Agent.
MaaaAV Land and Ronk PO Rox 1767 Indio. CA 92201
Name of Applicant (please print) 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.
nn f11P
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I UG3S
A. .4- �'7-9f} 10
f0 A11� !t).AO
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 -Surely Bond
if required
TOTAL: $ 10.00
Receipt No. '
Received by Date
Recorded by
I
0602
PERMIT VALIDATION
0602
PERMIT NO.
DATE APPROVED
4/27/90
EXPIRATION DATE
4/27/90
DATE ISSUEDf/
4/27/90
By
Administrative Authority
TELEPHONE: (619) 564-2246
-; ,
NOTE:
With proper validation
m this form constitutes an CITY OF LA .QUINTA
encroachment permit
APPLICATION FOR PERMIT
`PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For they 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,111
DATE: / ( ® '0' Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
—�
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION t r F, " Sketch (attach construction plans if appropriate)
DESCRIPTION OF NSTRU,.. ION
DIMENSION -OF INSTALLATION OR. REMOVAL.
SIZE OF EXCAVATION, IF NEEDED
0
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION '
ESTIMATED CONSTRUCTION COST $;
(Includi:;c rarriov.al of aii nhgtruction, 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 termi 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 Apo&nt or Agent JI,
Name of Applicant ease print) , Business Address , Telephone No.
Name of Contractor anq Job Foreman Business Address Telephone No.
Contractor's L'j, se No. ' ` City Business License No.
Applicant's IIUrance Company Policy Number
FEES: Subdivision Improvement Permit —Class Ill
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1� 0
Minor:'Improvement Permit — Class IV: See attached schedule l�
Inspection Fee $ PERMIT VALIDATION
Permit Fee PERMIT NO.t
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: (619) 5642246
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