0939'NOTE:
With proper validation
this form constitutes an ,
encroachment permit
CITY OF LA QUINTA
APPLICATION, FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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
DATE:
LOCATION OF CONSTRUCTION
(Street address or pescription of Location)
Subdivision Improvement Permit —Class 'II I
Minor Improvement Permit Class IV
VA LLF-70
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION -OF CONSTRUCTION DEAVEW AY APPROAUt FUZ. f;1 EZ51DE COLAkmf
STA WA R D W. 207
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:
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 pe
ryrmit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of tis wor.
Signat�f Applicant or Agent
U Eu1 GEM' 91AI LDER& P D. W)( 21-101 ?ALM DIESEET 73LI(P- 'A to) y
Name of Applicant (please print) Business Address Telephone No.
3DE 54UEV_/_ 0HftJ "ADDOX
Name of Contractor and Job Foreman Business Address Telephone No.
7-,SZZ I1
Contractor's License No. ` City Business License No.
8LA i LDUZS S1AZ 1 F.T`( SE.PZV ICC 5 SOT LU 3 A CC
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' $
ZO.00
Permit Fee Id ' 0V
Penalty
Cash Deposit -Surety Bond
if required .
TOTAL:
Receipt No.
Received by Date
0005i8l�1�0� 039T0M 8-90 30.00 0
N°. 0939
PERMIT VALIDATION
0539
PERMIT NO.
DATE APPROVED Il -z g �9 0
EXPIRATION DATE
12—OS� �Q
DATE ISSUED
B,
Administrative Authority
Recorded by . 11 TELEPHONE: (619) 564-2246
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NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY' OF LA QUINTA
ec
APPLICATION FOR PERMIT-
PUBLIC
ERMIT PUBLIC WORKS- CONSTRUCTION (ENCROACHMENT) ''rte p W4 t
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 I f r
DATE: (� �' r � p Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 0 VA LVE -:Y0
(Street address or Description of Location) { '
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION QfL.1.UEt, A A�'�'•�ZOA61�f ���� �,����(�� � �V����{
DIMENSION OF.INSTALLATIONrOR REMOVAL ,
' SIZE OF EXCAVATION, IFNEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN w '
APPROXIMATE TIME OF,COMPLETION r
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. `
k 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 t Ordinances, the terms and conditions, of -the p� mit and'all applicable rules and regulations of the City of
La Quints and to pay for any additional replacement necessary as the result of t(rh'is work. .•
' Signatu%e-of Applicant or,Agent'
` J QUI C :�v AL1 l L F o, Y 1 x-10 V FALM '02SEVIT . 31 -►La,-' 914th 1 q
Name of'Applicant (please print) Business Address Telephone No.
Name of Contractor. and Job Foreman Business Address . Y Telephone No.
Contractor's License No. + .^ �`. City .Business License -No.
I IAiLL7 K UI t. -F -1`f' i2V1C '� BO�'UP AJC_. '
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs . 0 . - , p qq i•-2$" 90 �'
I CASH i'1QTAL 1 30.0
Private improvements: 3% of estimated construction costs-.
Minor Improvement Permit — Class•IV: See attached schedule
Inspection Fee $ 00 PERMIT-. VALIDATION.
Permit Fee ,0 ` 0U 't PERMIT NO. 0'1' 9
Penalty /l
Cash Deposit -Surety Bond
DATE APPROVED
if required !Z-05`- y0
EXPIRATION DATE
TOTAL: ' . $ :50. 00 , .'.,, .
DATE ISSUED Q� f
Receipt No.
B
Received by Date v Administrative Authority
Recorded by TELEPHONE: (619) 564-2246