0921!se • s rR..; *—+. :d t� t�"d +?4 ..R•� _�- .— �•:.. I—V
• ». e iii � �sj� �„♦' ♦• � • i .. �. !:� tf '�<: ,." •` r v . •. -.. ,r •
' NOTE: ;. 1 <• '�`,-f . A r, ti _ 4 f r ' . i
` With proper,validation '."Ir
> * this form constitu"tes an '' 7"`
r • t. a, - ,� . >. CITY• OF LA QUINTA
.y - encroachment permit
'- APPLICATION' FOR PERMIT
•. i.t. °,' PUBLIC' WORKSr.CONSTRUCTiON.(ENCROACHMENT)*'. �
r - Ls•
OF
r For`the construction; of -public or:private. curbs,'driveways, pavements, sidewalks, parking lots,, sewers, water mains
r , ` and other like public''works improve men' ts•in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.'
�.'-' ' �' Subdivision Improvement Permit — Class'III
'DATE: November •19, . 1'990,, . Minor Improvement Permit Class IV
k,
LOCATION OF CONSTRUCTION Ave 50..,w/s "711' W/O .Sdc. COY at`Adams -behind sidewalk
a (Street address or Description'of Location)'
'4,adjust.' exist tel box ':,t . grac�'�
PURPOSE'OF CONSTRUCTION Sketch (attach construction plans if appropriate)
-see attar hpd r1rauai n?
,
DESCRIPrTI'ON�OF CONSTRUCTION pi - and
• rare tel boxto' arade •.. - >
v pex GTE permit #0889
DIMENSION OF INSTALLATION OR;REMOVAL 6 x 8 C011di.tOri$ of permit ;0889 shall
apply to this permit
"• 4' x4' xP� deem
SIZE OF EXCAVATION,.IFNFEDED ' ,
f' ,M APPROXIMATETIME WHEN WORK WILL BEGIN 11/12 /90
'"APPROXIMATE'TIME'OF'COMP.LET.ION
2 days K.
ESTIMATED CONSTRUCTION 'CO.ST $ -
', (Incl'uding removal of all obstructiori, materials, and debris,,backfilling, com- -
' •.'paction.and,placing permanent resurfacing and/or "replacing improvements) `
Irl consideration "of'the granting•of this' permit, the applicant, hereby agrees to:
rindemniiy,•defend and save the City, its authorized agents, officers,, representatives and employees, harmless from and,against any and all
-'penalties;'•liabilities or joss resulting, from claims or, court action and arising.out of any accident,;loss'or damage to persons or property. ,
'.t happening or occurring as'a pgroximate.result of any•work undertaken, under the permit granted' pursuant 'to this application.
Notify the Adrninistrative,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 forany' additional replacement necessary as the result of this work..
e 17 1A
' •Slgnatu a ofAppllcant or.Agent' \
' r Herman. `9eisskei In''c '2820 NndustribLl ' Rd. Hloomincrton CA ' 92316 .714-877-2470 .
Name of Applicant (please pri,nt). s' Business Address,. Telephone No:
Name of Contractor and Job Foreman Business'Address Telephone No.'
'.r..>�:"� . '183556 ,' .. w'.165.1
i Cantractor's;License No. • .' ` City Business License No.
on file
Y, Applicant's Insurance Company- Policy Number
.• ,
;FEES+ 'Subd#ivision Improvement Permit—Class III:5f8 p g2Al
1v
! iAR i T l 1 80.00
•. Public improvements: 3% of estimated construction costs
*.'Private improvements: 3% of estimated construction costs-
` Minor'Improvement Permit — Class IV: See attached schedule - �''?
Inspection,F.ee .$' tY 80.00'. , ' 'yPERMIT VALIDATION ' • r
'permit Fee �x,. • "� - "` ..� •..""`; 0921 • ' ^
PERMIT NO.
;Penalty ,. ! >,
r s DATE APPROVED ll/19./90 .
Cash Deposit -Surety Bond_ ;
if required .EXPIRATION DATE 12/31/90 '
TOTAL: $' 80.00 `` 11/i19/9 f
DATE ISSUED�j D
Receipt No.
By
Received'by Date • Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
' 1��.t't'+4i.•�.w.-_ib- �-�, --v.:-;,r a �lw'.'Fw� .- �'.S�-.`%S` rJe��: -:.'sf"L-ti..-r•,�...+�'.:.....+.lb;� w': s,. �knp;'2:'�..i, d;,• ...%.'s �J+•
3
yam,, y. .v•Y6.V�l..',.,- �' r.r Yr ':i.' .... r w qe: F_ •y!3. w w..�s•..r.. p!•.9• .r. �, .�.*.y'IK+ !pi..as.- i9-.7►R+ wy' .r'+�i •...or -w. wa w�..• a. a....r �.-wr- w• it
4
NOTE:
With proper validation,
this form constitutes an
encroachment permit
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
DATE
November 19, 1990
.y
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Ave 50. w/s 711' w/o Sec. Cor at Adams behind sidewalk
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
adjust exist tel box t0 gra Sketch (attach construction plans if appropriate)
see attached dirawi nc�r
DESCRIPTION OF CONSTRUCTION nlaorP concrete nad and
raise tel box to arade
per GTE permit #0889
DIMENSION OF INSTALLATION OR REMOVAL 51611 x 814" conditions of permit
apply to this permit
i
SIZE OF EXCAVATION, IF NEEDED 4' x4' x4' deep
APPROXIMATE TIME WHEN WORK WILL BEGIN 11/12/90
0889 shall
APPROXIMATE TIME OF COMPLETION 2 dans
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.
ZAR LV, A-ZT.
SignAure o A plicant or Agent
• Herman Wei.ssker Sric. 2820 Wndu6trlal Rd. Bloomington CA 92316 714-877-2470
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
183556 1661
actor's License No.
on file
City Business License No.
Applicant's Insurance Company Policy Number
FEES: . Subdivision Improvement Permit — Class I IIt5i8AS'N S2OTA� i9—�0 I0•QO V
Public improvements: 3% of estimated construction costs j J H
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 80.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 80.00
Receipt No.
Received by Date
r
N7 V V
PERMIT VALIDATION
0921
PERMIT NO.
DATE APPROVED 11/19/90
EXPIRATION DATE 12/31/90
DATE ISSUED -11//19/90
By
Administrative Authority
Recorded by II TELEPHONE: (619) 564-2246
- - : Uinta
City of La Q �.
AUG 0 i
PUBLIC WoTtKs J PERMIT NO.o-41592
WORK:: of nF ' a- 18
City of La Qui nta
78-105 Ca1Ie,.Fstado
L.a DUi nta, CA 92253.
H