0829NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONST RUCTION, (ENCROACHMENT)
SNE '7"R►.P ovE2SIZE. LOA. PE-RmiT
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— 14-9 Q Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION -FERNANDO 4 CISF_ til KOWE'K
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE- EQ U.IPM F_ NT Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION D B"K D D ZHAUL R O BITE� R
0N. Q,Srhl14OL1,IE►Z TO �El>✓S
WASHINC7'TON, N115 TO, AVE�_*9.
DIMENSION OF.INSTALLATION OR REMOVAL 1W' 1i0 IDE- F_/6 Tb ��N� PALMS V` S�F�
(05' lokIG LEGAk. 14E,16F- STORM CNA/VNE(..._ V:`
• SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 9-/y 9 0
APPROXIMATE TIME -OF COMPLETION
ESTIMATED CONSTRUCTION COST $ ON DRY DAILY
(Including removal of all.obstruction, materials, and debris, backfilling, com- PILOT CRIZ REQU 1 ZED
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..- .
Signaturlof Applicant or Agent
SJANJDOAt' CD. PO, .8OX .903 COLTOM CA CIZ3ZLI fjA :877—Z1ZCo
Name of Applicant (please print) Business Address ' Telephone No.
3 H T CD►U ST.
Name of Contractor and Job Foreman Business Address Telephone No.
OW FILE
Contractor's License No. City Business License No.
FlIeEMAAIS FUND Z q 3.M XX 8049800 9
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III ism 8,7 1q 70 i 4--90 10
f0, tASH i TOTALM10.00
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs Q
Minor Improvement Permit — Class IV: See attached schedule 9 "
Inspection Fee $ ) PERMIT VALIDATION
Permit Fee /0100 •
PERMIT NO. 82'9
Penalty
Cash Deposit -Surety. Bond
if required
TOTAL: $ %O D
Receipt No.
Received by Date
Recorded by
CT -/9— 90
DATE APPROVED L
EXPIRATION DATE
DATE ISSUED
y�
By
l/Administrative Authority
TELEPHONE: (619) 564-2246
i � 't },,.h `1•:;;a:� n-r#9M.=.., .. a .ii iw ShciA•e'3LS.-�IY1 ..•� : { ''! 1- i ..• 7 7^
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NOTE
With proper' validation 2
` this form constitutes an
encroachment permit , -
CITY OF- LA' QUINTA
APPLICATION FOR PERMIT
i PUBLIC WORKS CONSTRUCT_ ION (ENCROACHMENT)
JP
For the construction' of public or private tcurbs, , ,drivewa s
y pavements ,'sidewalks, parking• lots, sewers;. water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS .
` w Subdivision Improvement Permit'—
Class. l 11
DATE:, 14-9 d Minor Improvement Permit -Class IV *.
LOCATION OF CONSTRUCTION FERMANDD 4' E)SF k M QWF_'
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION M Q� - FQ UIPM F MT w Sketch (attach construction plans if appropriate)}
'09L i bZ.. HAUL ROTA
'DESCRIPTION OF CONSTRUCTIONw
. ���i •Ota! � i•S�'I�! �'VGI��l�, .7•'•U •��LE�
i W A`Til NbTs 1V j 'N18 TO A VEqS�
DIMENSION OF INSTALLATION OR REMOVAL Iql L, %Ili E,%6 ,,V Q( AIE PALMS
tom ' t no C,l L F_ 6 A L 4 F 16 I+T '570KM CNANNE Lr,,: -�•
.SIZE,OF EXCAVATION, IF NEEDED "
APPROXIMATE TIME WHEN WORK WILL BEGIN- /qd
APPROXIMATE'TIME OF COMPLETION rl _
li ESTIMATED CONSTRUCTION COST.$ 'ON Ay d L%
(Includm
ing'reovakof all obstruction, materials, and'debris, backfilling, com- PILOT CR� �) p -
paction and, placing permanent resurfacing and/or replacing improvements) ti
In consideration of the, granting of, this 'permit, -the applicant hereby agrees to: + c
Indemnify;•defend and save the City 'its authorized agerits; officers, representatives and employees, harmlessfromand against any and all
penalties, liabilities• or loss resulting from claims or court action and'•arising out of any accident, loss or damage to Iper sons,or property '
1 happening or occurr7 las a,proximate result of any work undertaken 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. -
#.
• - _ Signaturlof Applicant or Agent
Name of Applica(n/1t (please print) , Business Address Telephone No.
Name o�f'j�v+Contractor andJob Foreman Business Address Telephone No. +. '
Contractor's License No. City Business License No.. ti
Fl %eC=M AAJG FMN t7. tZ 9 5M X X' OT1s 0`� I.
Applicant's Insurance Company r Policy Number -
A
FEES: Subdivision Improvement Permit — Class l I I Q c��o n 4_9' f 10
io to?i � �ilAty'� o , cio
4, 1 Public improvements: 3% of estimated construction. costs
Private improvements: 3% of estimated construction costs e f p '
29
Minor Improvement Permit — Class IV: See attached schedule_ 8
Inspection Fee $ PERMIT.VALIDATION
Permit Fee, ` d ~4 CO 8.2 9
• PERMIT NO.
Penalty �.. R„' ��... O
Cash Deposit -Surety Bond r DATE APPROVED.
if required EXPIRATION DATE 9'' /T 9 0
TOTAL: $ JO 00
DATE.ISSUED"''��� �U
J` Receipt No. �„ �f�lsL�/7l.✓a r/Yt/�._
y
Received by ` Date ;• '; AAdministrative Authority
' Recorded by TELEPHONE: (619) 564-2246
7
,.• ,
I L
(4OTE:
,With properwaiidation>
this form constitutes an CITY OF LA t]UINTA
encroachment -permit
APPLICATION, FOR"' PERMIT I$
5
PUBLIC:. WORKS, CONSTRUCTION- (ENCROACHMENT)'
_. For the construction of `public. or private• curbs: driveways, pavements, sidewalks; parking lots, sewers, watermaina,,
and'other like, public •worics improvements- in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit—, Class I I I
DATE: !2,,./ Minor•ImprovemenVPermit'Classw
LOCAT{ON O CONSTRUCTION:: h Ay 1 L)TA A *1C%A L)30
(Street addressor Description,ot Location) -
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if approprilm1,=
�.9e✓r�� X7i5firV14Vui1E/C
DESCRIPTION OF CONSTRUCTION. • �- ,
SAS • . T a yr /s S /� il/Ct 70 /✓
IMENSION F INj TAL TION OR FIEMOVAL �lkty N��3' 7c:,� �� a g7.4 57'
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTiMATED.CONSTRUCTION COST $
(Including removel.of.all obstruction,', materials, and debris, bafkfilling, com•
paction and placing permanent resurfacing and/or replacing improvements) (rem—, Cfi4(4 rR'�'O
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 damagwto- Persons, or immarty
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 advence'of the time when -work will be started.
Comply with all applicable City Ordinances; the term= and conditions of the permit -and all applicable -rules and regulations of the City of
La Quints and to pay 'for any additional replaeemenrneaass•ry es the result'of this work.
e '
s Signature o Applicant or Agent
Name of Applicant (please print) Business Address Telephone No.
o an 41usiness Address— T_el.ephme-No.
Contractor's License No. o.
�..
�i4644 4AI � AAIVd - Zgj xX 80 Y y 8�e q
Applicant's Insurance Company Policy;Number
FEES: Subdivision'Improvement Permit —Class III
r Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor improvement Permit — Class IV: See attached schedule N.
Inspection Fee S jI PERMIT VALIDATION
Permit Fee
PERMIT NO.
Penalty DATE APPROVED.
Cash Deposit -Surety Bond '
if required EXPIRATION DATE '
TOTAL: $ DATE ISSUED
Receipt No. ,
By
Received by Date Administrative Authority
Recorded by _ TELEPHONE: (619) 564.2246 -