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NOTE: .. /
With proper validation
O
this form constitutes an i.
j ,encroachment permit CITY OF, LA OUINTA
i- APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION' (ENCROACHMENT)
" + �l0F
" ONE TRIP OVERSIZE -LOAD TERMIT "
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: N12.5/90 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION' - - -- - -
V C+ r7 LGIC/ LVLLiJ . ,
(Street addressor Description of Location)
PURPOSE OF CONSTRUCTION T*?RN 9""IATA Sketch (attach construction plans appropriate)
%DESCRIPTION.OF CONYSTRUCTION. ` haul ROUT,
• , _
52- WEST. 31' SOUTH' ON BERMUDAS
WEST ON COLIMA ,•
DIMENSION OF INSTALLATION OR REMOVAL
' -DATE HAUL ON 5129-,
SIZE OF•.EXCAVATION, IF. NEEDED
APPROXIMATE TIME WHEN WORK�WILL BEGIN ,
APPROXIMATE TIME OF COMPLETION ' Y
ESTIMATED CONSTRUCTION COST $ ,
(Including removal of all obstruction, materials, and debris, backfilling, com'Y
paction and 'placing permanent resurfacing and/or replacing improvements)
In consideratiori.of- the :granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save`the City, its authorised, 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. '
k • • ♦ ^
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
• • + -9 - .
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 kadditional replacement necessary as ,the result of this, work. �, a
Signature of Applicant or Agent
MJ1c.cF.V CA7\Til ATTII' i?r1C'fCC
Name of Applicant (please print)' F Business. Address Telephone No.
C,. Rte• tL '
r ` Name of Contractor and Job Foreman Business Address '. TelephonerNo.
Contractor's License No. '' City Business License No:
Applicant's Insurance Company " Policy Number
FEES: Subdivision Improvement Permit -Class III'
Public improvements: 3%L of estimated construction costs 05182 i0 4643 0-25-90 �0
.. -; o?0 _•,CASH t 7 DTAU • i J-0.00
Private improvements: `3/0 of,estimated construction costs0666-
Minor Improvement Permit -Class IV: See"attached schedule 4
Inspection Fee $ ! �. �6 PERMIT VALIDATION.
Permit Fee PERMIT N0, 0615 .
Penalty ,
Cash Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE
TOTAL: $
DATEI SSU D
Receipt No. '
By v •�
Received by Date `"'""'� Administrative Authority
Recorded by TELEPHONE: (619)•564-2246
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L
.
NOTE:
With propee validation
this form constitutes an CITY OF LA QUINTA
encroachment permit �1.
y APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
UIUJ� TRIV UVERbIZZ LUAU ll+ERMl'1'
For r 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: %125/90 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION ----- — — — -- —
V V JC+t�L� l Lr JCS LUHL
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION3rnnvD r_xarvrsv Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 1 n t TA?InV haul ROUT
r;;!^✓—� J Jha wGi t 3_gg? 52 WEST I SOUTH ON BERMUDAS
WEST ON COLIMA ,
DIMENSION. OF INSTALLATION OR REMOVAL
DATE HAUL ON 5/29
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. t
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.
Z, X if
Name of Applicant (please print)
Signature of Applicant or
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 I II
Public improvements: 3% of estimated construction costs 0 518:? 4643 05-25-90 14
Private improvements: 3% of estimated construction costs ' L'A , J 6 OTAL 1 � J. 0.00
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
$. in nn
Date
PERMIT VALIDATION "
PERMIT NO. 0666
DATE APPROVED — —
f "_01
J V
EXPIRATION DATE /oma /an
DATE ISS S gp2ri/-Wn
By`�� Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
i
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC `WORKS CONSTRUCTION (ENCROACHL
ONE TRIP OVERSIZE LOAD PERMIT
For the construction. of public, or private curbs, driveways, pavements, sidewalks,
CITY OF LA OUINTA
r
005i82 10 4643 05-25-90
and other like public works improvements,in connection with MINOR IMPROVEMENT MISC. 1 i0.00
0013200032025
10 CASH i TOTAL i i0.001-
' j Subdivision Impr i AMOUNT TI.: : NDERED " 10.0,0
DATE: 5/25/90 Minor IrrCHANGE •.00
LOCATION OF CONSTRUCTION
,`.
THANK YOU
(Street address or Deicription of Location) i• .
PURPOSE OF CQNSTRUCTION$A' 1i:n QR-ERNN Sketch (attain r.......
DESCRIPTION OF CONSTRUCTION lg 6Y91DE haul .ROUT
he!ght weight legal . 52. WEST & SOUTH ON BERMUDAS
_ WEST ON COLIMA
DIMENSION OF INSTALLATION OR REMOVAL
DATE HAUL ON 5/29
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 thi 'work.
Signature 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 II
Public improvements: 3% of estimated construction costs 005iB2 Q 4643 05-25-90 10
Private improvements: 3% of estimated construction costs ��iii0 (. (a 1H 1 TOTAL i 1.0:00
66
Minor Improvement Permit — Class IV: See attached schedule iV� 0
Inspection Fee $ Q ' Q II PERMIT VALIDATION
Permit Fee y
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No;,'.
Received by Date
Recorded by
PERMIT N0. D666
DATE APPROVED 71 25190
EXPIRATION DATE
DA4 ISS E
By
Administrative Authority, '.
t
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
SATE:
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class III
Minor Imp;ovement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
1��'d�r°J� . S—s" Ptpl'L :P Sketch (attach construction plans if a
y , ppropriate)
77
c
DE CRIPTI N OF ONSTRUCT ON/,G/ W,r-��
141
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME O
ESTIMATED CONSTRUCTION COST $NGS / '✓
(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 his work.
/ A
S' ature of Applicant r Agent
of Applicant Alease print) Business Address Telephone No.
'Name of Contractor and pb F reman k Business Address Tele on o.
Contractor's Lice e No. City Business License o.
. .. .AA
Applicant's Insurar '-Company 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 r
Inspection Fee $
Permit Fee.
Penalty
Cash Deposit -Surety Bond.
if required
TOTAU�.._._ ._y_...._ .............. _._
Re
S Ipt N4
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
Administrative Authority
TELEPHONE: (619) 564-2246