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0815R, 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 I I I DATE: 9-5-90 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION — MOVE EQUIPMENT (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION Rpnc! g 1 Q N WT"Mtt 9 A I UTt"", o 9 1 T. + WTMWV r__p' VN7 TATVTr`TT# DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Sketch (attach construction plans if appropriate) 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: ROUTE NOG ALES AND MENDOZA TO BEIM S 2 OUT OF CITY LIMIT DATE 9-5-90 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. / Name of Applicant (please print) gnature of Applicant or Agent. Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. on PTT.P Contractor's License No. � City Business Licenserava 'No'" (►NAT VTT.T; Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class 111 Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: 1n nn $ 1 n nn Receipt No. Received by Date 0815 PERMIT VALIDATION PERMIT N0. T1 f5ASN T NO. 4f5ASNtgQTA�-15~90 10.0 014 DATE APPROVED 9-5-90 --��-6-90 EXPIRATION DATE DATE I SSU,ED��= By /`C. AGF -4 `_-� Administrative Authority`""' Recorded by 11 TELEPHONE: (619) 564-2246 r r, T1'fnlelrFaY6¢^�Gmi�rf+.aa¢'Y'M�'l.+�ar'li t3MW'"�4f"�+ r .M W fa-t� w ►L r. rnW K?r r i. N ri �+ M 4� r a �i �r r �1. N rr YY �W r �i M w w -r r� V� +� r �YAI. w^ rr� �i �► Y 4. W �ti M �+n oma , 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: 9-5-90 LOCATION OF CONSTRUCTION HOVE' EQUIPMENT (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION PPOC! rtaTPM 1 O i G? n 1,7T q1LY 1 e1 1 MTr_M C r t TjPW4 R MW 4-1ZP V -,Ni VF1!, T('rVTj DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Subdivision Improvement Permit — Class I II Minor Improvement Permit Class IV Sketch (attach construction plans if appropriate) 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: RODU`fiEE NOGALES AANND._MENDOZA T It BER SqU-5l OUT OF CITY LIMIT DATE 9-5-90 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. p Name of Applicant (please.print) ture of Applicant or Agent Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. nn 7*'1'T,T•: 9N. pilr ". Contractor's License No. City Business License No. ON PTT. Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class I I 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 $ Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No 1n_f�() Received by Date PERMIT VALIDATION 8wPERMIT NO. f DATE APPROVED 9-5-90 E) P'I R AT I'O N -DATE -9-6-90 DATE ISSUED­!��_';_90 By Administrative Authority .,. Recorded by 11 TELEPHONE: (619) 564-2246 NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment per • 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 MINOWIMPROVEMENTS and APPROVED SUBDIVISIONS DATE: LOCATION OF CONSTRUCTION�a� (Street address or Description of Location) ` Subdivision Improvement Permit —Class III MJnor Improvement Permit Class IV PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) I D SC IPTION 0 ONSTRUCTI N 9' /1 Dl,�fL°,' /�® li S j` �2!?u�%�e �i > 70 DIMENSION OF INSTALLATIO. OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN /Lp APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris, ba -*filling, com- paction and placing permanent resurfacing and/or replacing -improvements) In consideration of the granting of this permit, the applicant hereby agrees to: Indemnity, 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 Quints and to pay for any additional replacement necessary as the result o this work. ' Name of Applicanf(please print) Signature of Applicant or Agent Business Address Telephone No. Name of Contractor and Job Foreman Business Address Tele7ee ne No. Contractor'sLicense No, 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 Improvemeni Permit —Class IV: See attached schedule Inspection Fee $ Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by . Date Recorded by N° PERMIT VALIDATION PERMIT NO DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE: (619) 5642246