0864tiw..P ..i.e�Eat+Fa.'i.�: �':.'�ar'+�6�=►�.r..YrK-: ws, '.! 5n oa. «n - rs r-.,. w..... w w +fa +Y: Yr .r .a .i .r. w w i. w. w+�
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE LOAD PEM11T
For the construction of public or private curbs, driveways, pavement's, 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: 10-09--90 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION rIP" aC[t�i C111fG Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 966 loader HAUL ROUTE:
15"n.109W
waahington and £red waring.s/b
to52 w/b to bermudas s/b to
DIMENSION OF INSTALLATION OR REMOVAL nogb lon
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION HAUL DATE: 10-09-90
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
Name of Applicant (please print) v Business Address Telephone No:
Name of Contractor and Job Foreman Business Address Telephone No.
nn filo An fill
Contractor's License No. City Business License No.
On fi l n on filp
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 10.00
Received by Date
Recorded by
d4x� �O�to � r4ITOIAL0i9�9U x.o4d
PERMIT VALIDATION
PERMIT NO. 0864
DATE APPROVED 110-09-90
EXPIRATION DATE 10-09-90
DATE ISSUED 10-099D , 90
a
!`% Administrative Authority
TELEPHONE: (619) 564-2246
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i ,
�
`�►Y is rw nM� P �+. �.s b+'- — — — - — r Y — — — Y M — — �l — W M & ---------------
NOTE:-----w-----w--
NOTE: j9. '
With proper validation r
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE LOAD PERMIT
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: 10-09-90 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION move equipment Sketch (attach construction plans if appropriate)
DESCRIPT ON OF CONSTRUCTION 966 loader
15'r W
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
HAUL ROUTE:
washington and fred Waring s/b
to52 w/b to bermudas s/b to
nogales
APPROXIMATE TIME OF COMPLETION HAUL DATE: 10-09-90
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Gln -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. f
Name of Applicant (please print)
Signature of Applicarif or Agent
Business Address
775--48
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
on file -
on file
Contractor's License No. City Business License No.
on file on file
Applicant's Insurance Company Policy Number
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
t
Received by Date
07'ALpi �y0 1U.do
PERMIT VALIDATION
PERMIT N0. 0864
DATE APPROVED 10-09-90
EXPIRATION DATE 10-09-90
DATE ISSUED 10-09e 90 a
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
• ' ..s a+.rr �.. :ee.� .. _ �.� .�� .� � �� r-� �n..r �.� .w �.� �� �� �...� .ter. w �.
NOTE:
Wlth propor validation
this form constitutes an CITY OF LA QUlNTA !
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 111
DATE: Minor Improvement Permit Class IV _-
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESC`RIPT)ONpF CONS�T,RUCTION
DIMENSION OF INSTALLA
OR REMOVAL -Gf/
��� ►' / <
SIZE OF EXCAVATION, IF NEEDED P
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
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 1241 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 f. this work.
Name of Applicant,(please print)
Name of Contractor and Job Foreman
Contractor's License No.
ature of Applicant or Agent
Business Address
Telephone No.
Business Address T ephone No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs
Private improvements:; 395 of estimated wnsirmifln wits
Minor Improvement Permlt — Class IV: See attached schedule
Inspection Fee $ I
Permit Fee
Cash Deposit -Surety Bond
if required
TOTAL;
Receipt No..
Ricdivid by bate
NU•
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
��
EXPIRATION DATE
UID
Ely r,:e..,,..,..,..
Adipinittrative Authofltl
Recorded by 11 TELEPHONE; W19) 564,M§