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NOTE:'
With proper validation
..I k Q'
this'form constitutes an
encroacFiment"permit �. - CITY OF- LA QUINTA -
• AP.
PLICATION FOR PERMIT � $
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)c�
1 ' .!' ; • ^ i i ` OF
For the . consf�ruction 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, r
' •, . .a t ` '• r Subdivision Improvement Permit— Class I I I
DATE, May 31, 1990 p• ^ ° r Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION ' 1411es _AVen ES/S Fxcxm Dune paha - tb- A�lama Etreet
' '' ` � - Yet• z' .. :h. . -
(Street address or Description of Location)
w
'PURPOS OF CONSTRUCTION Sketch (attach construction plans if appropriate) ,
• .r: "ri�aa,ni9-.`��4r�e•t• •Mrsiy'A�h t . s,
'DESCRIIPTI 0N OF CONSTRUC TION'+
"*1 x►nf "ey o•^"i4f- fail
.. �;.�, .i. �•• - F ,._ refer - ence.'GM permit 4 0536,,.~,
.NSION OF INSTALLN O
DIMER REMOVAL • @
CONDITIONS -01? PERMIT 0536 Y .
LL .•ATIOr. APPI; • TO ;T'HXS 1>ERM1T . • fa.
SIZE OFA
EXCAVATION; IF NEEDED'. - • . _ , , �^ , '
-i.APPROXIMATE-TIME WHEN•WyORKWILLIBEGIN'".52.1'40. 2A
APP.ROX`IMATE TIME OF COMPLETION - ��l hX`lQh
+ .EST4 TEb*CONS'TRUCTION COST $
(Including'iein val.of•all�obstruction, materials, and debris,`backfilling, com
paction and Vplacing permanent resurfacing and/or 'replacin'g improvements) '
In consideration~of the.granting,of this permit, the'applicant hereby"agrees to + r
4111,
Indemnify, defend rand save the City, itsauthorizedagents, 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,.los's or damage�to persons,or property
happening o� occurring as a.pAoximate result•of'any work: undertaken under -the permit granted pursuant to this applications `
•,Notify ,the'Administrative Authority at -least twenty-four (24)• hours in advance of the time when work will -:be started. ` =y
iComply with all applicabWCity Ordinances, .the terms and conditions of•the permit and all applicable'rules and regulations of the City of
5 La Quints and to pay any additional replacement riecessary`as the result of this work.
•'i =�* • '_ r ' i `w� yt, i Af�M6�'�..,i� 'GS.Ms«1�i�� -`4' • ~ .. - y r' •�•
gnature of Ap'Iicant'or Agent' Z':
c1� ki �tf- c� >a�rx•t #- �ax� I�a �=�3545"0• 4317:SthtA St.' k0n7l
Name of Applicant'(please" print) A Vt '•I _s 'Business Address • �, Telephone No: �f
.i - • .^�- �. , y. • - ... •'it w.: •, ..�•?• y =fit.' - �. •5
Name f, Contractor and Job Foreman * t;. Business Address • . 'Telephone No: ,
Contractor's -License No. j City Business License No.+
'rir%tA *` '` • 6C�»C 3 � f t;' i-_"64Ib.4t�
Applicant's Insurance Company' ' t �' ''Policy Number ''
`,FEES: .Subdivision Improvement Permit —'Class IIIdayq + s 0 cc'('C 00.4 6 /��. 0
Public improvements:,3% of e'stimated�construction costs . ' permit. feet 10.00 , ill. 00 -
- ' Private improvements: 3% of estimated construction costs , <w '� 00'
Minor Improvement Perrnit — Class IV:'See attached schedule
Fee
Inspection = 630, 00 '• ,
p :,$ � '' I , ' ��• �'PERMIT'VALIDATION'•
Permit Fee 10.00
Penalty,
Cash Deposit -Surety Bond- '
if required
'TOTAL: $ -`640.00
Receipt No. ,
Received by Date
Recorded by '
PERMIT -NO. -4 •0672
1 .
-^ DATE APPROVED 5/-31/90 . '
EXPIRATION DATE "'12'/31/90 rr
DATE ISSUED-', �" NO
r
By
R
Administrative Authority
TELEPHONE: (619) 564-2246.
-- — M 4 — — — 4 —ewe — — — — — — baa — — — — — — — — r— — 110
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
(' Subdivision Improvement Permit — Class III
DATE: Mt3y 31, 2.990 . - Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Miles Avonue. SIS From Dune Palms to Adams Street
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION S ��� �" t�� �" '�'On�
fAf-*i 1 i fionn� #.,n f- rAe--, -
DESCRIPTION OF CONSTRUCTION zal ��� n�cx-r�x�c3tai #- taxtd
nn�r�he,nl Aa a ..
DIMENSION OF INSTALLATION OR REMOVAL 4750 CY1CY
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/30/9n
APPROXIMATE TIME OF COMPLETION 6/2d/gf1
ESTIMATED CONSTRUCTION COST $ sD; DRR
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction plans if appropriate)
reference GTE permit IT; 0536
CONDITIONS OF PEP0IT 0536
APPLY TO THIS PEP0IT
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.
r _
Signature of Applicant or Agent
ShacJklett Construction Co 4307 State St. Ponoma, CA 91766 714/627-3545
Name of Applicant (please print) Business Address Telephone No.
Dick Snalson same as above
Name of Contractor and Job Foreman Business Address Telephone No.
194440-A
Contractor's License No.
j� IC
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
630.00
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
$ 640.00
Receipt No.
Received by Date
12 dayo 0 $45.00 m $630.00'
permit foe 10.00 10.00
� oIlk 0 0
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
0672
5/31/90
a 2/31/90
EXPIRATION DATE
DATE ISSUED
Byv,J, ' A
Administrative Authority
Recorded by I' TELEPHONE: (619) 564-2246