0791a..�..w.:o�++,�'.,n!..�.R�..t+��'-!••�"�. fir..-...-�.al
NOTE:,
With proper validation
- �i .this form constitutes an' ' ^' .. C
�:. encroachment permit CITY OF LA QUINTA -
'
�' APPLICATION FOR PERMIT
PUBLIC , WORKS ,CONSTRUCTION (ENCROACHMENT)'
OF ffl89ti
For the construction of ,public or private, curbs, dnlveways, pavements,, sidewalks, parking lots, sewers, water mains
and other'like public works improvements in connection with MINOR IMRR_ `OVEMENTS and APPROVED SUBDIVISIONS
' t Subdivision Improvement Permit — Class'l 11
`DATE: August 20; 1990 `+ Minor Improvement Permit Class IV
TR 243.17-3
LOCATION OF CONSTRUCTION
' (Street address or Description of Location)
4
PURPOSE OF CONSTRUCTION -street lml�royenlents Sketch (attach construction plans if appropriate)
and, storm drainage "
DESCRIPTION OF CONSTRUCTION +
as per gpprofed plans on file
DIMENSION OF INSTALLATION OR REMOVAL
r
�i.. SIZE OF. EXCAVATION; IF NEEDED
'''••''A• APPROXIMATE TIME WHEN WORK WILL BEGIN
, r ` - :•fir, ' r ,..ltN ,h : ,
APPROXIMATE TIME OF.COMPLETION '
' ESTIMATED CONSTRUCTION COST $
• , (Including removal of all o¢struction, materials, and debris, backfilling, com-
paction
om paction and placing pernianent•resurfacing and/cr replacing improvements)
In consideration of the'"granting of•this permit, the applicant hereby agrees .to: .' 4
Indemnify, defend and'save the City, its -authorized agents, officers, representatives and employees, harmless from and against any and all aA
penalties,.aiabilities 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 gran"ted pursuarit•to this application.'
' v -Notify the Administratiwe'Auihorityfat least twenty-four (24) hours in advance of,the time when work will be started.
Comply with all applicable City Ordinances, the terms and,,00nditions`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
1,or
11 a'
a ry Signature of,Applicant or Agent
National-Mortage and -Land Co. 42-600 Cook Ste. Ste..200 Palm Desert 568'-2828
Name of Applicant (please print) Business Address Telephone No.
sire
Name of Contractor and Job Foreman Business Address' r i ; Telephone No. '
288130' '.328
• Contractor's License NO. : y - City Business, License No.
•,Aetna,' General Liability 083ACM5726732; Workmens.Comp,CKO'06873CSA
,Applicant's Insurance Company Policy,Number,ti'
1. • • ' i '� , ' _ ; -.
FEES: Subdivision Improvement Permit — Class III
Public improvements:,3% of estimated construction costs i 0p5182 i�0 776 TO 2 i-90 f 0
-.70 •; C SH i 0 4_ 1155.04
t Private improvements: 3% of estimated construction costs - e r�
y N2 0791.
Minor Improvement Permit — Class IV See attached schedule ` r
Inspection Fee $T 1,155.00, ! PERMIT VALIDATION
Permit Fee PERMIT.N04
�.
Penalty., •/U %L'S I,;r�
JCash Deposit -Surety Bond ♦ -� DATE APPROVED a
-if required EXPIRATION DATE (4J�
TOTAL $ ]: _ 1 5 5 _ 0 f1
,DATE ISSUED
Receipt No.
By . s. it _e
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
.c
•
4
- �i .this form constitutes an' ' ^' .. C
�:. encroachment permit CITY OF LA QUINTA -
'
�' APPLICATION FOR PERMIT
PUBLIC , WORKS ,CONSTRUCTION (ENCROACHMENT)'
OF ffl89ti
For the construction of ,public or private, curbs, dnlveways, pavements,, sidewalks, parking lots, sewers, water mains
and other'like public works improvements in connection with MINOR IMRR_ `OVEMENTS and APPROVED SUBDIVISIONS
' t Subdivision Improvement Permit — Class'l 11
`DATE: August 20; 1990 `+ Minor Improvement Permit Class IV
TR 243.17-3
LOCATION OF CONSTRUCTION
' (Street address or Description of Location)
4
PURPOSE OF CONSTRUCTION -street lml�royenlents Sketch (attach construction plans if appropriate)
and, storm drainage "
DESCRIPTION OF CONSTRUCTION +
as per gpprofed plans on file
DIMENSION OF INSTALLATION OR REMOVAL
r
�i.. SIZE OF. EXCAVATION; IF NEEDED
'''••''A• APPROXIMATE TIME WHEN WORK WILL BEGIN
, r ` - :•fir, ' r ,..ltN ,h : ,
APPROXIMATE TIME OF.COMPLETION '
' ESTIMATED CONSTRUCTION COST $
• , (Including removal of all o¢struction, materials, and debris, backfilling, com-
paction
om paction and placing pernianent•resurfacing and/cr replacing improvements)
In consideration of the'"granting of•this permit, the applicant hereby agrees .to: .' 4
Indemnify, defend and'save the City, its -authorized agents, officers, representatives and employees, harmless from and against any and all aA
penalties,.aiabilities 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 gran"ted pursuarit•to this application.'
' v -Notify the Administratiwe'Auihorityfat least twenty-four (24) hours in advance of,the time when work will be started.
Comply with all applicable City Ordinances, the terms and,,00nditions`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
1,or
11 a'
a ry Signature of,Applicant or Agent
National-Mortage and -Land Co. 42-600 Cook Ste. Ste..200 Palm Desert 568'-2828
Name of Applicant (please print) Business Address Telephone No.
sire
Name of Contractor and Job Foreman Business Address' r i ; Telephone No. '
288130' '.328
• Contractor's License NO. : y - City Business, License No.
•,Aetna,' General Liability 083ACM5726732; Workmens.Comp,CKO'06873CSA
,Applicant's Insurance Company Policy,Number,ti'
1. • • ' i '� , ' _ ; -.
FEES: Subdivision Improvement Permit — Class III
Public improvements:,3% of estimated construction costs i 0p5182 i�0 776 TO 2 i-90 f 0
-.70 •; C SH i 0 4_ 1155.04
t Private improvements: 3% of estimated construction costs - e r�
y N2 0791.
Minor Improvement Permit — Class IV See attached schedule ` r
Inspection Fee $T 1,155.00, ! PERMIT VALIDATION
Permit Fee PERMIT.N04
�.
Penalty., •/U %L'S I,;r�
JCash Deposit -Surety Bond ♦ -� DATE APPROVED a
-if required EXPIRATION DATE (4J�
TOTAL $ ]: _ 1 5 5 _ 0 f1
,DATE ISSUED
Receipt No.
By . s. it _e
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
-�l�eos�rf�eem+.*+Tt4»`�+� ��T�"^ w .r. ,e. r �.. a..'a. =--..,.+, �.; .� w ww w. �.. rr ... � r .r: r r w r +® v� �b• .r r w►.� n. rr w s .�:. sr r.� �. w a► V. .. r. er. t�
F �5,
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: August 20, 1990 Minor Improvement Permit Class IV
TR 24317-3
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION street imt.)rovements Sketch (attach construction plans if appropriate)
and storm drainac.�e
DESCRIPTION OF CONSTRUCTION
as per ppprofed plans on file
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-
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
e 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 re su It of this work:
Signatur"e of Applicant or Agent
National 14ortage and Land Co. 42-600 Cook Ste. Ste. 200 Palm Desert 568-2828
Name of Applicant (please print) Business Address Telephone No.
rte -
Name of Contractor and Job Foreman Business Address Telephone No.
288130
328
Contractor's License No. City Business License No.
Aetna, General Liability 033ACM5726732; Workmens Comp CK006873CSA
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 $ 1,155.00
Permit Fee
Penalty"
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 1.155.00
Received by Date
Recorded by
0, 'Ji82CASH7 i TO pL i 9Q S m. 0�0
0791
PERMIT VALIDATION
PERMIT NO. 0791
DATE APPROVED to /-Z
EXPIRATION DATE 7
DATE ISSUED �0 7 {�
�• r
Administrative Authority
TELEPHONE: (619) 564-2246