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NOTE: s
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 I I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION *•�+++� ��++�*���+�*+T
ra a+ L vaa r.yrwa _
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION WTT)P. T,QAn Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
11 10 •WTnF HFTrHT WFTrHTOT,VrAT,
DIMENSION OF INSTALLATION OR REMOVAL
HAUL ROUTE JUAREZ &ARROBA TO BERMU
NOR TH ON BERMUDAS EAST -ON 52
NORTH ON WASHINGTON TO 111
1
SIZE OF EXCAVATION, IF NEEDED
HAUL DATE 2/29
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,advanc6 of the time when work will be started.
y r
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.
a
Signature of Applicantor Agent /
Name o ` pplicari .please print) Roe�S •v.BOXi �lusiness Addrels L' 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 aftached schedule
et f' t—
Inspection Fee $ '
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
. TOTAL: $
Receipt No.
Received by Date
Recorded by
'005182 10 4644 05-25-90 i0
10. CASH i 1*07AL i 1.0:00
NO 0665
PERMIT VALIDATION
PERMIT NO. 0645
DATE APPROVED,
EXPIRATION DATE
DATE. ISSUED an.
`r 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)
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 I II
DATE:—tea a o Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION .Rnf 1T- T/�t 1fr.AATT�
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION' WTT)V.. T.OAT) Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION - no RR
.11 10 WIDE; HF..TOHT WPTrR_'T'�T,PrAT, HAUL ROUTE JUAREZ &ARROBA TO BE:
NOR TH ON BERMUDAS EAST-gN,52
DIMENSION OF INSTALLATION OR REMOVAL NORTH ON WASHINGTON TO -11f'
SIZE OF EXCAVATION, IF NEEDED
HAUL,DATE 2/29
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 of Applicant o Ar gent
Name o `App(ica t (pl ase pr t) Rl5e. to
r .0 rw t7CRusiness Address �A 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
005182 i 35M90ASH TOT011-25-90
s Q. Ua ,
NS 0665
PERMIT VALIDATION
PERMIT N0. DIhF5
DATE APP ROVE
EXPIRATION DATE G /1)0 /Qn
DATE ISSISS ED�/�r c�/9,R/cin Y
By.
r� Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper validation CITY OE LA OUTNTA
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT -
PUBLIC WORKS CONSTRUCTION (ENCROAt
005182 10 4644 05-25-90
For the construction of public or private curbs, driveways, pavements, sidewal r - 10
and other like public vvorks. improvements in. connection with MINOR IMPROVEME MISC, i 10.00
001320002025
•
I10 ' CASH I TOTAL ,i 10.00
.. .
Subdivision I Ai"iOUN f TENDERED
CHANGE 1• '��' • 00 ..
DATE: �f a a / a n - M+inc .00.
LOCATION OF CONSTRUCTION
THANK YOU
(Street address or Description of Location)
PURPOSE'OF CONSTRUCTION WT F_ i.OAD Sketch'.(atta'ch coiistrueLio,,,,,.o.....,
DESCRIPTION OF CONSTRUCTION – DOZPR
11 10 .WIDE HEIGHT WFTGHT T,RGAT, HAUL ROUTE -JUAREZ &ARROBA. TO BERT
NOR TH. ON BERMUDAS, EAST ON. 52
DIMENSION OF INSTALLATION OR'REMOVAL NORTH ON WASHINGTON TO 111
SIZE OF EXCAVATION, IF'NEEDED
HAUL DATE .5/29
APPROXIMATE TIME WHEN WORK WILL BEGIN -
M
tAPPROXIMATE 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 orproperty
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.
Signature of Applicant or Agent
Name o pp Ican (p ease print)ROCKbuXUsines s Telephone No.
Name of Contractor and Job'Foreman Business Address Telephone No.
Contractor's License No. City Business License No,
R
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III _
Public improvements: 3% of estimated construction costs 005182 i0•' 4644 05-'25-90 10
Private improvements: 3% of estimated construction costs AT
10- CASH i TOT ,L i :i. 0.00
Minor Improvement Permit - Class IV: See attached schedule' N2 0 6 65
Inspection Fee $ II . PERMIT VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $+
Receipt No.
Received by ,.Date
Recorded by
PERMIT NO. 0665
DATE APPROVSL
EXPIRATION DATE�� /ten
DATEI UE
By
Administrative Authority
TELEPHONE: (619) 564-2246
I:
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA OUINTA
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
1
Subdivision Improvement Permit — Class I I I
.DATE: ,�' / Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION E.-!� Z"4 4=42W-40 '
(Street address or Description of Location) _
PURPOSE OF CONSTRUCTION �„��� Sketch (attach construction plans if appropriate)
DESCRIPTION OF
DIMENSION OF INSTALLATION OR REMOVAL
dtV
5
SIZE OF EXCAVATION, IF NEEDED eq /1J
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 wgrk. A
me of Applicydnt (please print)
ature,pf Applicant or Agent
Business Address
Telephone No.
Name of Contractor and Job Foreman Business Address Tele one No.
r
Contractor's L' e n e No City Business Lice se No.
Applicant's Irvurance Company Policy Number
FEES: Subdivision Improvement Permit — Class II I
Public improvements: 3% of estimated c9wructiQn cpits
Mute Improvements., 3% of estIMated aonstructfon coots
Minor Improvement Permit — Class IV: See attached schedule .
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TQTAL; $ .. _
Receipt No.
Re861ve8 by bate
Recorded by...�_._....----
N0
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
Administrative Authority
TELEPHONE; (619) 564.2246