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NOTE:
With proper validation;
this form constitutes an
A CITY OF LA-QUINTA ?o
encroachment permit !
- APPLICATION FOR PERMIT.,-
,, PUBLIC WORKS- CONSTRUCTION (E NC ROACH MENT)••`I'.
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
DATE1.: I.I - Z�" 9 O ;
.,_' Minor'Improvement Permit Class IV
LOCATION OF CONSTRUCTION 5 VA LLLT0.,
(Street address or Description of Location) -
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION' DK\VEWAY APPROACH `, p�R. PWERSI DE *aDU(UiY
STANDARD:
•I j
,.
DIMENSION. OF:INSTALLATION OR REMOVAL
+,. SIZE OF°EXCA-. VATION,'IF NEEDED +
. .. -
". APPROXIMATE TIME WHEN WORK�WI LL BEGIN. , {,
*APPROXIMATE'TIMEOF, COMPLETION
ESTIMATED CONST RUCTION•COST'$•
- "(Including removalrof,all obstruction, 'rrikerials,,and debris, backfilling; com .
• ' action and. p I acing permanent resurfacin and/or.• re lacin • improvements)
Inconsideration of the granting of this permit, the applicant hereby agrees.to:•
Indemnify,.defPrid'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 andconditions mi
of the pert 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:
r, Signature of Applicant or'Agent ►
+'
MEW GE10ERAT)DN.' L`DERS- P. D', BOX Z40 I' PAt:tii D����-T,.'�+ C�'iq 3�-I(�'tiN�iW.
. ; Name of Applicant (please print)' Business Address a , Telephone :No.
50E:BAUEK.;�3'DHU RADDDX h
Name of Contractor and Job.Foreman- 'Busi6e'ss Address'
Telephone ' No.
r , ,
0` - .��
' .E'"r:iContractor's License No.., i �,• +City Business License No.
`&A1LDERS SURIETY SEKVICIE>SA:�C
a Applicant's Insurance, Company ;. Policy Number
♦.
FEES: %Subdivision,Impravement Permit — Class l 11
"+ r
Public improvements: 3% of estimated construction cost's `+ �` ' OpSf'8'' iQ 8391 'i 1-28-90 10
10 SASH i TOTAL 1 30.00
Private improvements: 3% of estimated construction costs pro` ` . Q
3.9 Minor Improvement Permit —Class IV: See attached schedule
Inspection Fee- $ U'.D L x` PERMIT _VALIDATION
PermitF r PERMIT NO.' `
Penalty > } ♦ , C;.; y
Cash Deposit- Surety Bond '
c
• DATE APPROVED �' ;•
if required w 1t' EXPIRATION DATE
TOTAL: $- 30 O U1
_ Z
`
..w ,DAT
Receipt No.E+ISSUED' %' '
s y M
}, ♦ u
Received by Date
. `•Administrative Authorit •
,
Y
Recorded by �' 'r ♦ TELEPHONE: (619) 564-2246
�r �i6"'�'� �-' � . -'_ �'[.� Ig1Q�✓"�/:-M Al w rc� � rw w M �b . EA !i +!4 w .�'•P`- l� w-! !!� �l • w wY M €�' t= 4T B• � w T a �► wt � ?. r. w � s w� w �. w w.�f �Y
sr
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
It -'7_9- 90 Subdivision Improvement Permit— Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION LI M) VAS LLLSO
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION �I v\V,:,VJAy APPROALH
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
?`E_R KW E M I IDE CDU.VTY
TA►11DAF.D M0. Z07
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 (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 wor
R M
Signature of Applicant or Agent
MEW GN AS )D4i!"lLi ERS !--,D,UX 7_40t PaLtil bt, � ; `T Cela LI(u114
Name
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.
111LOFI iu 1 TY � 1C 005"2to3 AkC
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 2-01017
Permit Fee W-00
II
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
,O.00
Received by Date
PERMIT NO
005182 3._q 8394g,, 11--28-90 i.0
9) CAoaH i 7QTAL 1 30.00
N11% n -,
PERMIT VALIDATION
t, q ..`fir j3
DATE APPROVED
EXPIRATION DATE
II-Z.b' 19D
DATE ISSU D-1
! i
By V,
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246