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0749NOTE: ` With proper validation r""` this formconstitutes an ' encroachment permit " CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) t 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: 7-23-90 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION MOVE EQUIPMENT (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction,plans if appropriate) DESCRIPTION OF CONSTRUCTION CAT D-7 D07,,FR - 11"10" WITH.,14'HEIGHT 65 LENTH WEIGHT GREEN DIMENSION OF INSTALLATION OR REMOVAL HAUL ROUTE HWY 111AND WASHINGTON n/b TO -FRED WARING AND e/b TO--RA.NCHO ACATILLO f SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 0518 A 1 596R73-90 10.0014 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 thetAdministrative 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 +/ '-LY 7 G 4 V G - -- - Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address } Telephone No. ON FILE nnT FTT.F Contractor's License No. City Business License No. ON FILE 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 �T Minor Improvement Permit — Class IV: See attached schedule Ns. 0749 Inspection Fee $ II PERMIT VALIDATION Permit Fee _ I , g Penalty Cash Deposit -Surety Bond if required 10.00 TOTAL: $ Receipt No. Received by Date Recorded by PERMIT NO.. 0749 DATE APPROVED 7-23-90 EXPIRATION DATE 7-23-90 7-23-90 DATE ISSUED � ., Administrative Authority TELEPHONE: (619) 564-2246 . r .ti-- -� ., � ,r.. ��'- •�.. - �,- � J-.. ...x,. , ... ...r,.. .t,,, .,ey,T,,.,��,-w� ti -. � ��n ,. v..y .c .�,�, ....�.� ...`t:• tet,' �s� ��'fE�"��-�+'�+!-1•+.s"'+.y�.Fa'a.'t►y`n?(`*+ r�.r a iw i. ,:. w� ix .r r .ti w r. r...r w .r ... w e. a+ �:. r i+ r • r•�...�.... w ! � r-ir. w..r ..i-ws :l rs r•: w .-' , ,fie -. . � V•�� 1 NOTE: i�, 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: 7-23--90 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION MOVE EQUIPMENT (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION CAT D-7, DOIR HAUL ROUTE HGJY 111AND >; WASHINGTON 11"10" WITH 14 HEIGHT 65 LENTH WASHINGTONn/b TO FRED WARIN� IGHT GREEN AND e/b TO RANCHO ACATILLO DIMENSION OF INSTALLATION OR REMOVAL �+ i SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 105i8el 1H 5,958 58 R 13-90 10.0014 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 rapplication. Notify the\tAdministrative 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 IN Name of Applicant (please print) Business Address Telephone No. 1 Name of Contractor and Job Foreman Business Address Telephone No. ON FILE Contractor's License No. ON FILE ON F'TT.r,. 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 „ 0749 Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ Permit Fee I n ;t Penalty Cash Deposit -Surety Bond if required 10.00 TOTAL: $ Receipt No. Received by Date Recorded by 0 PERMIT VALIDATION 0749 PERMIT NO. DATE APPROVED 7`23—�Jy EXPIRATION DATE 7•-23-90 DATE —19 -S -OED' /7-23-90 By Administrative Authority 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 /> Subdivision Improvement Permit — Class III DATE: Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION r % (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF,C N RUCTION - � �[! ©�'�� —" //lam. /0 Ifzfr DIMEN ION OF INSTALLATION OR REMOVAL J /LSIZE OF EXCAVATION, IF NEEDED ` ��� APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION 0/ _V 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 nuinta and to pay for any additional replacement necessary as the result of. this work. Name of Applicaft (please print) of Applicant or Business Address Telephone No. Name of Contract an Job Foreman Business Address Tel phone No. / Contractor's Licenn No. City Business Liceanse No. Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit - Class I I I Public improvements: 3% of estimated construction costs Privat@ imprgYoments; A gf mimatod Guitrumign Gom Minor Improvement Permit — Class IV: See attached schedule s Inspection Fee $ Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL;....: Me --6610i No.. pia&68 by Recorded by bate N0 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE SUN Adf. Ini5trative Authority TEEEPKNE; W-19) EE4=2249