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0868I 4. NOTE: �. :' , • - �. . w .4, With proper validation "' ' r 2• : ,ihis,form constiiutes an CITY,:OF 'LA QUINTA `encroachment;permit • , • -� • ' `APPLICATION FOR' P_ ERMIT • ' ';` , ` � � .. r•� PUBLIC WORKS CONSTRUCTION "(ENCROACHMENT)''. _ * SOF r88� ± • For' the -construction , of public or private curbs, 'driveways, pavements; sidewalks, parking -lots, sewers, -water' mains and ottier like -public works improvements in.connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS _• Subdivision Improverrient Permit — Class I II • October 15, -1.•990 f ' '3 DATE.:- -+ r Minor`Improvemenf Permit Class IV • LOCATION OF CONSTRUCTION 'Washington St..-Sta... 135 00 to" Stas, 144485.89 •• . ' (+•(Street address or Description of Location) ' t ' . s"' ,-� 4 . , PURPOSE OF:CONSTRUCTION n9- r. Sketch (attach construction plans if appropriate) DESCRIPTION,OF CONSTRUCTION 1awe_: • c.'xi q:A ncr+ Plr•i'omd t ` i, - cable and. manholes - reference GTE Permit 0839 :conditions of permit -?.0839a 'y DIMENSION OF•INSTALLATION OR REMOVAL` '2 ni.tci,shall ' apply.`to: this permit `` SIZE OF EXCAVATION; I'F NEEDED • s ti.�. ' Y • ... . , '4 + • • t . n .'1' • •� , Y 1 ist �• ' -APPROXIMATE TIME WHEN WORK WILL'BEGIN_U/1b/9U APPROXIMATE TIME'OF,COMPL•ETION 0/31/90- • • ' . ` f ESTIMATED± CONSTRUCTION -COST $ �.. , ` .. (Including removal of all obstruction; materials, and debris, backfilling; com- • , ±� e paction and placing permanent resurfacing'and/or replacing improvements) s" " In,considerationrof the granting of this permit,! the applicant hereby agrees to: - ;r f i ° ;�._'�- , • ;`• , indemnify, defend and save the City, its authorized agents,•officers,'represe'ntativesYand •employees, harmless from"and against any and all ' penalties„ liabilities'or loss resultirig•from claims or court action and+arising.out of any~accident; loss or damage to persons or property _ ,'t�f happening or occurring as a proximate. result of any work undertaken under the permit `granted pursuant`to'this application: 1 ,-• Notify'the Administrative Authority at least twenty-four ('24►t hours in advance of the time when work will be started.- • �' t 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 rep lacement -necessary as the result sof this work.- Sig II► .� " , • 1v ' !`• y � ,1 F '` - • ,• sF •..•Iy \ AV. 1.1 �'�• J• • ', . ' , • " . •' ,y Sigriat a of-Ap.plicarit or Agent HErman'-W issker,}Inc. 2820 Industrial Dr.~ Bloomington, 'CA 92316 Name of'Applicant (plea `se print) -�. ' A Business Acl&ess `. Telephone No. •• Name'of Contractor and Job Foreman Business ,Address , " ' ' ' "' ' Tel No. 183556 _� :. ~ ,� i' .• �' t +'`3 1661^ Contractor's License No. ,� . ' ` ''City Business License No. Great A,niericanY Ins,. `QLP2814682' •,. �: •.F:: = Applicant's Insurance Company., . v 'r e . *. ,�Y . k ' Policy Number FEES: : Subdivision'Improvement Permit = Class III • , ; 5 days .@ $40'.-00 - 'public improvements: 3% of estimated construction costs •� '' • : Private . m.•3%of estimated'consti 8 � 5-90' i0, ets: �ucfion'costs jAt 1 1 200.00 Minor Improvement,Perrnit — Class IV:,See attached schedule '� t *.: t - Inspection Fee '$' 200. 00 PERMIT VALIDATION . Permit•Fee _ ��* �.:. ..,._ 0868 �� PERMIT NO. ` Penalty x DATE APPROVED 10/•15/90. Cash Deposit Surety Bond . ` .' ' 1" ,`. _ :. ,. N ' if required '.EXPIRATION DATE 10/31/90 TOTAL: $ 2.00 _ on 10/16/90 DATE ISSUED- • Receipt'No.. By Received by - Date '`—� Administrative Authority Recorded by •TELEPHONE: (619) 564-2246 � - . e4R+r.fraK'w ,My.91 �'A �ra� W� :.,, w r r..w ... w Yo �. A f. r-s� r. r r..r r- R..r..w ,.s r.• w N. nr,... r ^ r r .ww► �. -rr. .+ r r .► w e. -w !w x dry NOTE: With proper validation this form constitutes an encroachment, permit <. IM 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 Subdivision Improvement Permit — Class I II DATE: October 15, 1990 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Washinctton � 1r. Sta. 135ta00 to Sta. 144+85.89 (Street address or Description of Location) PURPOSE OF CONSTRUCTION street imnroaempm DESCRIPTION OF CONSTRUCTION 101,30X' existing biiri d cable and ranholes DIM5ENSIO 200 F INSTALLATION OR REMOVAL 211 i f= SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Sketch (attach construction plans if appropriate) APPROXIMATE TIME OF COMPLETION 10/31/90 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: reference GTE Permit 0839 conditions of permit 0839 shall apply to this permit 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. �oli1 Signature of -Apples nt or Agent HErnlan Weissker, inc. 2820 Industrial Dr. Bloomington, CA 92316 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. 183556 1661 Contractor's License No. City Business License No. Great American Ins. gLP2614602 ° 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 $ 200.00 II Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: $ 200.0': Receipt No. Received by Date 5 days @ $40.00 m $080.00 PERMIT VALIDATION 0868 PERMIT NO i1 V90 200.00 0 DATE APPROVED 10/15/90 EXPIRATION DATE 10/31/90 DATE ISSUED 10/16/90 �.o Byfr3� Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 NOTE: With propervaiidatiom 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; wratWmaim"- and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS: Subdivision Improvement Permit — Clais III DATE: to " 15' 90Minor. Improvement Permit Class IV LOCATION OF CONSTRUCTION, ATO -r 06 144 (Street address or Description of Location) PURPOSE OF CONSTRUCTION ST,��r Im PPz✓Er►f rj' - Sketch lattach construction pians if appropriamt'r DESCRIPTION OFC019STRUCTION• LntJ Fxi, id t;�Rlz'EP l3cGS 4 [M4A'g0 G DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED Z APPROXIMATE TIME WHEN WORK WILL BEGIN 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: 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 prape iy• happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. M Notify.the Administrative Authority at least twenty-four (241 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 appikable rules and regulations of the -City of La Quints and to pay for any -additional replacement,neassery as the result of this work. Signature of Name of Applicant (please print) ' Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City -Business License No. Applicant's Insurance Company Policy Number ' FEES: Subdivision Improvement Permit —Class Ill Public improvements: 3% of estimated construction costs Private improvements- -3% of estimated construction costs Minor Imorovement Permit — Class IV. -.See attached schedule Insoectlon Fee S Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by Date Recorded by N° PERMIT VALIDATION PERMIT NO. 11 1 DATE APPROVED EXPIRATION DATE _. DATE ISSUED By Administrative Authority TELEPHONE: 1819) 564.2246. '