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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
DATE: June 25, 1990
Subdivision Improvement'Permit — Class I II
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION TR 79;900 Frpri• GTa.ri nrY an ri Aelamm
r .. y
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION IID trenching
r
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
conditions of permit 0692
shall apply to this permit
,"' 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 o Applicant or Agent
F.r- fel; 11 Y. pq r— AICC)r1 r_n�l, Q.I- 04-. 1_5 ---t Aalm Tl n-- r'A 1AR--71Rt11
Name of Applicant (please print) Business Address Telephone No.
G & R Underground 569e0 Panchita Rd. Yucca Valley, CA 365-1593
Name of Contractor and Job Foreman Business Address Telephone No.
469553 587
Contractor's License No. City Business License No. ;
AMI AMI binder 4201
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class II I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ C%3Z Of)
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$
Receipt No.
Received by Date
�$518A(� i3TOTALr�5_90432.00SO
0724
PERMIT VALIDATION
PERMIT NO. 0724
6/25/90 rt"
DATE APPROVED
EXPIRATION DATE 12 L31120
DATEISSUED 6/25/90
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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p
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
DATE: June 25, 1990
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION. TR- 7ci?-9fi Prarl Wari ner an rl Adams~
i
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION IID trenching Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
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-
action andlacin ermanent resurfacin and/or re lacin improvements)
conditions of permit. 0692
shall apply to this permit
P � P 9•P 9 P 9
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 or Agent
FF Uzi 11 i ami, lin Ai6n 1 rnnk S* P+n 1 Zai Palm n=Q=y1 CSA lAq-+7gA1
Name of Applicant (please print) Business Address Telephone No.
G & R Underground 569e0 Panchita Rd. Yucca Valley, CA 365-1593
Name of Contractor and Job Foreman Business Address Telephone No.
469553 587
Contractor's License No. City Business. License No.
kmi AMI binder 4201
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III 11 115$ 6-25-90 10
'A li TOTAL 1 432.00
.: Public improvements: 3% of estimated construction costs -
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $� tea
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$Z
i
Received by Date
Recorded by
PERMIT NO
0724
PERMIT. VALIDATION x
.0724
DATE APPROVED
6/25/90
EXPIRATION DATE 12/31/90
DATE ISSUED 6/25/90
By
Administrative Authority
TELEPHONE: (619) 564-2246