0900- - - - - - --- --- - W - - — — — — — — — — — — — — — - — — — — — — — — — — — — —
'With proper validation �' 2.
p
,+ this form constitutes an, ` CITY OF LA QUINTA
encroachment permit
APPLICATION FOR • PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) I•„„NSw4
ONE TRIP OVERSIZE LOAD PERMIT 0FI�9ti
„} 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 '
"Novembe , 7 , 1990 Subdivision Improvement Permit —"Class III
DATE' Minor Improvement Permit Class IV
• � LOCATION OF CONSTRUCTION 'move equipment
(Street'address or Description of Location) .:
PURPOSE OF CONSTRUCTION '450 Backhoe Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION • 14'6" high, 12-16 HAUS ROUTE:' AVE.='ontezuma e/b to'
w; dc --9,)!J lona Washington.; North to out of city
limits. .
DIMENSION OF INSTALLATION'OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED` .
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIM E'OF-COMPLETION'
ESTIMATE_ D CONSTRUCTION, COST $ -
(Including removal of all obstruction, materials, and debris, backfilling, come ;
paction and "placing permanent resurfacing, and/or replacing improvements) '
In consideration of the granting of this permit, the applicant hereby agree
. ,
,Indemnify, -defend and save the City, its authorized agents, officers, representa ' and emp gees, harmle f m d against any and all +
penalties, liabilities or. loss resulting from claims or court action "and ari ' t any acci t, Io r ma to persons or property
happening or occurring as a proximate result of ny wor under under he p mit granted pursuant to is plication.
Notify the Administrative Authority at least `twe ty-four (2 hours in adva ce of he time when work will -be start d.
Comply with'all applicable City Ordinances, the t ms -and c ditions of theerm' and all applicable rules and regulati s of the City of
La Quinta and to pay for any add itional.replaceme tmecessar as the result f is work.
•Signature,of Applicant or Agent
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 Improverrient Permit —Class 111” ;
Public improvements: 3% of estimated,construction costs -
Private, improvements:
osts_Private,improvements: 36/o of estimated construction costs,
Minor Improvement Permit — Class IV: -See attached schedule N6 -.0900
Inspection Fee $ PERMIT VALIDATION '
.Permit. Fee' PERMIT N0.
,Penalty'
Cash Deposit Surety Bond DATE APPROVED '
if required EXPIRATION DATE
TOTAL: $. DATE ISSUED
CIN
Receipt No. ^, r
By
'Received by. Date Administrative Authority
'
-Recorded by TELEPHONE: (619) 564-2246
.+",�ar�+, i' � ". L, �.�r iHy' f t :' i �' ,,Y�� ��. r 5 h. �� .j .i-- T K• t
' ,'�iarr�-z..�,+y��=� ��tr,`'.•�.-tii'�''.�'.�,4,„x,,,y'r14r1;?3,�'��`"�"�gx..��;��, ��• "si;,k ,'-_Ji1Y.v',•w�:��-�"zJ.,,�..:.3id'tE.�lt ray �ro."y"�.w�: y`�✓ �,r �-gf'
ok
NOTE
;3
With proper validation
`
2
this form constitutes an
CITY OF LA
QUINTA
encroachment permit
* ,
M
APPLICATION ' FOR PERMIT
r PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
.ONE TRIP OVERSIZIoT 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
November 7, 1990 Subdivision Improvement Permit — Class II I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION move equipment
a ,
(Street address or. Description of Location)
PURPOSE OF CONSTRUCTION 450 Backhoe Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 14'6" high, 12'6" HAUL ROUTE: AVE. Montezuma e/b to
wider� Washington, North.to out of city
,• limits
DIMENSION,OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, -IF NEEDED'
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: lid
Indemnify,•defend and save the City, its authorized agents, officers, representa_ti and empl'oyees, harm e s from against any and all
penalties, liabilities or, loss resulting from claims or court action and �arisin out ofd any accidAr�t, loss�or d magelto persons or property
happening or, occurring, as.a proximate result of tiny wor undertakefi under the permit granted pursuant to th,s application.
`. µ 'Notify the Administrative' Authority at least twenty-four Ours in advance of he time when work will be start`d.
Comply with all `applicable City Ordinances, the `rms and copditions of tJe ermit and all applicable rules and regulati\s 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
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.
Applica'nt'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 �" N2 4 q 0. S"
Inspection Fee $ PERMIT VALIDATION
Permit Fee PERMIT NO.
Penalty
.Cash Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE
TOTAL: $ DATE ISSUED
Receipt No.
BY
Received by Date Administrative Authority
.Recorded by r TELEPHONE: (619) 564-2246
w-�`.........",.s:•�;:.'sR4'.•ats..-�:;;-%�t�s:vri�.w+"'_'$,,;;��ss+.;st.:...'.�a%1:"�.e.�t`':�y''b`..sk-11;t;:sz4=:Fc+��:°'+► :'*r1t�J6f; .;�� 4i.�" `?, ..+.t: .r �it..?+. . yvSnii�n. �`�. ":3 �- �rt�S, Y,ts�•', '�.�-r+i�.��y.;
�. ' `' ' .. - i4!s- ' ..-.1V Y6 YIa Ys-iiF.•w�w �Y K R, N! My.q�Ml�l�.4Y' 4� is. is .�: �Cb 5t. , ...ne^l 4Y• ffi�.3'�s lA dl. -M1' w!!' �Ik - �,R..oa./ 4 M� �M T,--^ �.••..�• 4
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT.,
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZN 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
November 7, . 1990 Subdivision Improvement Permit = Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF..CONSTRUCTION move equipment
(Street address or Description -of Location).
PURPOSE OF CONSTRUCTION 450 BaCkhOE Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION, 14.' 6" high, 12'.6': HAUL ROUTE: AVE. Montezuma e/b to
uazdo-. 9q 11" 'lona Washington, North to out of city
limits
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 1;..
(Including removal of all. obstruction, materials, and debris, backfilling, com-
paction and placing permanent.; resurfacing and/or replacing improvements)-
In
mprovements) � \ /
In consideration of the granting of this -permit, the applicant hereby agrees�-
Indemnify,
\/'
fdef n v it i iz is ffic n ves an em to ees harmless from and a ainstan and all
e d and sa a the C is author ed a en o ers re rese tali d. Y, 9 P P Y 9 Y
1 i
Ppenalties, liabilities.or loss resulting from claims or court action and arisingout of an accident, loss.o�dama a to persons or property
9 Y ate— 9
'happening or occurring as -a proximate result of 4any Work undertaken<der the pe�mit granted pursuant to this application.
Notify_ the Administrative Authority•at least twenty-four 1244) hours in advance of the time when work will be startetl.
Comply with all applicable City 'Ordinances, the terms and conditions of the permitiand all applicable rules and regulations of the City of
La Quinta and to a for an additional re lacement necessary' as the result of this work.
pay Y P Y
Signature of Applicant or Agent
Name of Applicant (please print) Business Address Telephone No.
Narrie of Contractor and Job Foreman Business Address Telephone No.
Contractor's. License'No. City Business License No.
Applicant's:.Insurance Company Policy Number
j FEES: Subdivision Improvement Permit — Class I I
Public improvements: 3%•of estimated construction costs
Private imnroverrients: 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.
Received by Date
Recorded by
N`-' 9
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246