0859r�C}„f�-i_y �'M r F.�. Stib"a'fjw"'Mf•'RC�M'•W�'Y h�! V� +#. iE+ M �. — — — Ian •— — —Yrs — M fin. — M — — w — — r moi'— — -- — — r — — nom— — — — — — — — —
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION , FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE. TRIP UEERSIZE. LOAD PE_R:1IT
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: 10-03-90
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 1210un Pcstaa rarr_,nt Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 623h scram—r MAUL ROUTE:
jofforson and 48th s/b to
DIMENSION OF INSTALLATION OR REMOVA114IDb 10leu 110,0001bs ave 52
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN HAUL DATE: 10-03-90
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 of Applicant or Agent
NUEVO ENGINEERING ON FILA, ON FILE
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE
Contractor's License No.
ON FILE
City Business License No.
ON FILE. OE PILI:
Applicant's Insurance Company Policy Number
nnG<cra <n 10
`iii ' - PA.VH i TOTAL 1 10.00
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
!x.11 $10.00
$
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 0859
DATE APPROVED 10-03-90
EXPIRATION DATE 10-04-90
DATE ISSUED LD -03-90
Administrative Authority
TELEPHONE: (619) 564-2246
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e.re�..�yQ++�A.-���.i �t'a �.+wr'�� /q.; w4 rr�i► v.► w► er rl � r-� }..� w W..r-e ....P r r w e. r r r r v. w .r. va ail r.a .�a w .r .r .Y..�..� w w. M w .w r r �� r ... w r .w N .� w
Y
NOTE:
With proper validation ,
this form constitutes an CITY OF LA QUINTA V
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP UEERSI ZE LOAD PEIILMI '
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
10-03-90 Subdivision Improvement Permit — Class II I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street_ address or Description of Location)
PURPOSE OF CONSTRUCTION MOMM ecrui=ent Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVA110 h 10'w 110 , 000lb3
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
HAUL ROUTE:
Jefferson and 48th s/b to
ave 52
HAUL DATE: 10-03-90
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 of Applicant or Agent
NUEVO ENGINEERING ON FILE ON FILE
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Ota? FILL
Contractor's License No.
ON PILE
City Business License No.
OIC FILE ON FILA;
Applicant's Insurance Company Policy Number
.nne.•n n,Q•a � �a •�ar�c � A._r�'i(..,AFs (�
FEES: Subdivision Improvement Permit — Class I II
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.
!).)) $10.00
$ 10.00
Received by Date
Y
PERMIT VALIDATION
PERMIT NO. 0859
DATE APPROVED 10-03-90
10-04-90
EXPIRATION DATE
DATE ISSUED 1,0-C3-90
B�1/jv, ,
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
TOTE:
lith proper -validation
his form constitutes an
ncroachment permit
f'
i.
CITY OF LA QUINTA
APPLICATION FOR PERMIT
F 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
)ATE:jD - Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
'Street address or Description of Location)
)URPOSE OF CONSTRUCTION
DIMfPS�ON3F INSTALFATIQNI 1'NIOR REMOVAL QC
l Q _
Sketch (attach construction plans if appropriate)
Hold 9w_to
SIZE OF EXCAVATION, IF NEEDED C
PROXIMATE TIME WHEN WORK WILL BEGIN
AP
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 Quints and -to pay for any additional replacement necessary as the result of this work.
ti
Signature of ppli nt or Agent'
Nuevo Engineering, Inc. 79-811 Country Club Bermuda Dunes 619-345-1778
ame of Applicant (please print) Business Address Telephone No.
ame of Contramo� and Job Foreman Business Address 9/v Telephone No.
////
a
ontractor's Li se No. City Business Lice se No.
1 -La I - nw dj /0 ,
pplicant's Insurance Company Policy Number
EES: 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
Fee $
Irmit Fee
natty
sh Deposit -Surety Bond
required
TOTAL:
eceipt No.
ived by Date
N°
PERMIT VALIDATION
PERMIT NO. 'ot)S�
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
4
Administrative Authority
by TELEPHONE: (619) 564-2246
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