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NOTE:
With proper validation Q
this form constitutes an0
encroachment permit
CITY OF ` LA QUINTA
APPLICATION FOR •PERMIT -
PUBLIC WORKS CONSTRUCTION t(ENCROACHMENT)''��
.
(aiE THIP OVFIZ'51 "t.DAD PERMIT): 't�OF�g�
For the' construction 'of -.public or private. curbs, driveways; pavements, sidewalks, parking lots, sewers, water mains
• and other like public works improvernents in connection with MINOWIMPROVEMENTS and APPROVED SUBDIVISIONS
. I I - Z a- 96 �, Subdivision -Improvement Permit = Class;lll '
DATE: ' r Minor Improvement Permit Class IV
LOCATION OF CONSTRU_ CTION
(Street address orDescription of Location)
.
. .f
PURPOSE OF CONSTRUCTION Sketch (attach 1110\/E'�G�UIP.',, , .. ,.
construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION I B HAL1 L'..,, R0.t4 0.
Avg 52. ESB 70 7E- FE ' 'SO
^ DIMENSION OF INSTALLATION OR REMOVAL IHI H 101W. N/B .TO CITY.LIM,11, "
1 l bspb0 LM.'r..'
SIZE OFEXCAVATION,+IF NEEDED
- •• a -',
APPROXIMATE TIME WHEN WORK WILL BEGIN '
=APPROXIMATE �TIME OFCOMPLETION i HAUL 'DAVE : 11-2.0'-90
,ESTIMATED CONSTRUCTION COST $ •' ,
4 (Including removal'of all obstruction, materials, and debris, backfilling, coin
paction and placing permanent resurfacing and/or replacing improvements)` •�
In consideration'of the granting of this permit,'the applicant,hereby.agre'es to:
�• +
Indemnify, defend and save theCity,'its authorized,agenti, officers, representatives and employees, harmless from and against any and all
t' 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. v
Notify the'Administrative Authority at least twenty-four (24) hours in advarice•of the time when, work -will be started:
Comply with allrapplicable City Ordinances:the terms and conditions of the permit and all applicable -rules and•regulatioris of the City of
La Ouinta and to pay `•for any. additional replacement necessary as the result of -this work.
-odj-, I no( DI
r ' i f Signature of Ap,plicant,& Agent
...QIAEVO.'''.ENQs1NC EER11Vb 'a7q-AlI C,E.D.. `C . 3y S' 1778+••' '
Name of Applicant (please.print) • Business Address _j Telephone No
P1C -,'2+1A .
r- .� �• r i
Name of Contractor and 161J -Foreman Business Address' • Telephone No.
OAJ FI LE ..�, : ,ON F.) LF— ^
Contractor's License No. _ . City Business License No.
Dkl�, FILE: , ,� ;� `0K), F)LE
Applicant's Insurance Company! ; F -* + Policy Number
FEES:" Subdivision] m provement: Permit Class III
Public improvements: 3% of estimated construction costs . t door" iu 1p 8387 29 90 0
• Private improvements:•3%of estimated construction costs. -CASH .t TATflL i 10.0
0 D-3.7
Minor Improvement Permit — Class IV: See attached schedule.
+ . ',-
Inspection Fee' $ t� PERMIT
.
VALIDATION ,
Permit Fee 1 00 + O q 53 - '
. ►, PERMIT -.NO. '
Penalty _ ,
Cash Deposit -Surety Bond .DATE'APPROVED /,�? �d
if required -90
- 9 0
TOTAL:/ 0. 00 ' t
$ DATE ISSUED y I' - Z
Receipt No.
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
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NOTE: a
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:
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
J
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
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
Sketch (attach construction plans if appropriate)
u
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.
k J!:
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 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 $
r
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ J
Receipt No.
Received by Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
�
EXPIRATION DATE
DATE ISSUED.
By o i�
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
VOTE: •
Nith proper validation
this form constitutes;an. t, CITY OF LA QUI NTA
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 III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
Wrest address or Description of Location)
ho N(.D On, .nom
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENS ON F INSTALLATION OR REMOVAL � �a 1 }
i I �c�b Il h 7-) a_
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(including removal of all obstruction, materials, and deb: is, backfilling, com-
paction
1 g..
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 end 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 Quints and to pay for any additional replacement necessary as the result of this work. x
Signature of Appli i or gent
Nuevo Engineering, Inc. 79-811 Country Club,'Bermuda Dunes 619-345-1778
Name of Applicant (please print) Business Address 'Telephone No.
IName of Contractor and Job Foreman
s License, No.
icant s Insurance Company
EES: Subdivision Improvement Permit —Class III
Business Address Telephone No.
City Business Licen lyo.
I n ala
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs.
Minor Improvement Permit — Class, IV: See attached schedule
ispection Fee $
?rmit Fee
malty
ash Deposit -Surety Bond
required
TOTAL: $
eceipt No.
leceived by Date
lecorded by
Policy—Number
N�
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246