0619NOTE: j
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
May 2, 1990.
w „,may
Subdivision Improvement Permit — Class II I .
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Avenue 52. w/o Jefferson
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION move tel for Street Sketch (attach construction plans if appropriate)
DE CRIPT ON OF _CONSTRUCTION place cable as shown ATT dwg rr(JU :7,tlq
Reference Permit No,.
DIMENSION OF INSTALLATION OR REMOVAL 4 X4 & 40ft
t=^e 6'h
SIZE OF EXCAVATION, IF NEEDED 4' x41 140ft trench
APPROXIMATE TIME WHEN WORK WILL BEGIN '5/3/90
APPROXIMATE TIME OF COMPLETION 5/4/90
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
o:Indemnify,-defend and save the City, its authorized agents, officeis, 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•A_dministraiive 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
Tje% rnmmttnicaition 494 S. 4th Banning 714 $49/1121 -
Name of Applicant (please print) Business Address Telephone No.
Hood Communication
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 Insurance Company Policy Number
FEES:' Subdivision Improvement Permit — Class III inspection 2 days @ $40/day
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor.lmprovement Permit — Class IV: See attached schedule
Inspection Fee:
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$. 80.00
0.00
$ 90.00 .
Date
° 0619*
PERMIT VALIDATION
PERMIT NO. 0619
DATE APPROVED 5/2/90
EXPIRATION DATE 5/31/90
DATE ISSUED i 5/2/90
By C J k --L. Al
Administrative Authority
TELEPHONE: (619) 564-2246
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7:'
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
May 2 �• 19.90 Subdivision Improvement Permit — Class II I
DATE: Minor Improvement Permit.Class IV
LOCATION OF CONSTRUCTION Avenue 52 w/o Jefferson
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION move tel for street Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 'place cable as shown ATT dwg c,,uG-
Reference Permit No. C) j Y,
DIMENSION OF INSTALLATION OR REMOVAL 4 1 X4' & 40ft
SIZE OF. EXCAVATION,.IF NEEDED 4 1XV $40ft trench
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/3/90
APPROXIMATE TIME OF COMPLETION, 5/4/90
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 result,ing 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.
494 S. 4th'Banning
714 849/1121
Name of Applicant (please print)" Business Address Telephone No. '
Hood Communication
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 Insurance Company Policy Number
FEES: `Subdivision Improvement Permit = Class III inspection 2 -days. @ $40/day. .
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs'
N2 0619
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 80.00 PERMIT VALIDATION
Permit Fee 10.00 0619
Penalty
Cash Deposit -Surety Bond
if required
90.00
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT N0.
DATE APPROVED 5/2/90
EXPIRATION DATE 5/31/90
5/2/90
DATE ISSUE /
By� r
Administrative Authority
TELEPHONE: (619) 564-2246
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)
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
2,0 ti
PURPOSE OF CONSTRUCTION -,I9nuOL % / gnje -57 !e f f Sketch (attach construction plans if appropriate)
-J;R
DESCRIPTION OF CONSTRUCTION P C ajj3� :es
DIMENSION.OF INSTALLATION OR REMOVAL
-77-P Gk
SIZE OF EXCAVATION, IF NEEDED %/ c4
APPROXIMATE TIME WHEN WORK WILL BEGIN S — -3
APPROXIMATE TIME OF COMPLETION S y
ESTIMATED CONSTRUCTION COST $
flnclud:na rE:ncval of al!. 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 properly
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.
Signa ure of Applicant or Agent
Name of Applicant (please print) Business Address Telephone No.
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 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
Recorded by
N°
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564.2246
Administrative Authority