0952•
;NOTE:
' With proper validation
Vs form constitutes an •f _ ,�
- enc oachment permit CITY OF- LA;,QUI•NTA'/ -
• APPLICATION FOR PERM -f,..
1 PUBLIC. WORKS, CONSTRUCTION'`(ENCROACHMWr) c�• '' Sw�
a... ONE -TRIP OVERSIZE LOADPERMIT.
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
j S it •` �, r, i t "' '« ` '.^ .+ ' ih• -
Subdivision, Improvemeht Permit = Class'I I t' `
DATE: 'n �_� oa'n �'• '.Minor Improvement Permit Class IV
i. All
LOCATION'OF•CONSTRUCTION • A" MOVE • EQUIPMENT ; • '
(Street address or Description of Location)`
PURPOSE OF CONSTRUCTION .0 i-2-4 u Sketch (attach' construction plans if appropriate)
DESCRIPTION.OF CONSTRUCTION r, `•' '
r - HAUL ROUTE: SIB -ON JEFFERSON
•. , - i �.. W/B ON AVe. 52 ,
`DIMENSION OF INSTALLATION OR REMOVAL 141h, 10.1 w,
-110, 000 lbs"., .. Haul date:, 12/7/90
-¢ SIZE OF EXCAVATION; IF NEEDEDt' ;t
R APPROXIMATE"TIME,WHEN WORK WILL BEGIN
APPROXIMATE.TIME,OF. COMPLETION
' ESTIMATED.CONSTRUCTION'COST:$
(Including removal'of:all obstruction, materials`, and debris; backfilling, com= '• k , ��' — f �, L . ,
�+ paction.and;placing,permanent resurfacing and/or replacing'improvements)
In consideration'rof the granting�.of this permit, the applicant hereby agrees -to:
Indemnify, defend and -save the�City, its authorized•agents,' off icers,'representatives and employees, harmless from and against any and all ,
rpenaltiA,diabilities or loss resulting from' claims or court action and arising out, of any accident, loss or damage to persons or property
'
plicationor, occurring as•a proximate result of any work under,the permit granted pursuant to this ap:
>S t 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'ai4additional replacement necessary as the result of this work'., f r
o �haoj- I, nzyT)lP
;Signature of A"'plican�Jor Agent
i�lttat�r) �nrii naeari nc_- • 7A -'R1 1 ' C 0i 'ni-r�i C'7a`ah. R�?rmiada I�une�'' 3d_5 -1'77R
" Name of Applicant (please print) r `, Business`Address , Telephone No.'.
Name of Contractor and Job Foreman Business Address _ Telephone No. ,
Oii fi1�` •t •�, rn''fle,
f f
Contractor's License, No.., City Business 'License No:
ori. filer
Applicant's Insurance Company �. i Policy Number
m
FEES:". Subdivision Improvement Permit —'Class III
Public improvements:•3%of estirnated'construction costs - ' 005182 S.0 8576 12-07-90 i0
Y'Private,improvements: 3%.of estimated construction costs - i0 - GASI~! i 'TOTAL i 10.00 `
r 9
Min•or'Improvement Permit — Class'IV: See'attiched schedule-
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10.0 0 - 0952
PERMIT NO.
` .
Penalty•
Cash Deposit -Surety Bond
DATE APPROVED Y--2/7/90
if.required ` _ EXPIRATION DATE 12/7/90
TOTAL: $ •
Receipt No.
Received by Date
, r• • F,
Recorded by.
e DATE ISSUED 2/,7'/90
BY
` Administrative Authority
TELEPHONE: (619) 564-2246
y' '�. (�M..MN!'!!L4Y'�''+YbV�'+� �F- T�f M1� M •Yi T� —. w� �r MIP.Y r.�?. !`T .t w+� T�-!!r. �►i4 MIM'•,
!!� �►��r..— yw.M:T.w., �,M — -- ! - i1 i► - 1,-P e'er
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERM;I.<T
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONL TRIP OVERSIZE LOAD i ERF'=
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: 1;.;4; ; 1 A a n
LOCATION OF CONSTRUCTION 2OV F;a �UIPNIENT
(Street address or Description of Location)
Subdivision Improvement Permit — Class II I
Minor' Improvement Permit Class IV
PURPOSE OF CONSTRUCTION K Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
H2M ROUTE: SIH OF JEFFERSON
Gz/D ON AVe. 52
DIMENSION OF INSTALLATION OR REMOVAL 14111, 101W,
110, 00.0 lbs Maul �7ate: 12/7/:,0
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 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.
e
it
ignature of Applican'tjlor Agent
A7t��*��n :nrxi n o ri tr*c.
7oi-21 1 Cntintr-- Cl ane E,'orrim6a Dun, -4s 395-1778
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
on file m 'file
Contractor's License No. City Business License No.
on file
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 $ n:f"r,CIY
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$
Receipt No.
Received by Date
00502„ 0 857r t> -Q7-90
10 CASH i _,UiL i i0e0�
PERMIT VALIDATION
055?
PERMIT NO
DATE APPROVED 12/7/90
EXPIRATION DATE 12/7/90
DATE ISSUED 12/7/90
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE:
Nith proper validation
this form constitutes an
-ncroachment 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
/; Subdivision Improvement Permit — Class III
DATE: - ] - Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location) 1f
PURPOSE OF CONSTRUCTION Y Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION I�VJ(-CJS
DIMENSION OF INSTALLATION OR REMOVAL.-
-lLDi NM I L)a-�__
SIZE OF EXCAVATION, IF NEEDED
on
APPROXIMATE TIME WHEN.WORK WILL BEGIN
Iq D
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $.
(Including removal of all obstruction,
paterials, 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 undertakers 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.
Signature of Aylicaqor Agent
Nuevo Engineering, Inc. 79-811 Country Club, Bermuda Dunes 619-345-1778
Name of Applicant (please print) Business Address Telephone No.
Name of Contr and Job Foreman Business Address Telephone No.
gle
Contractor's Ocym No. City Business Li No.
117�4• ,
Applicant's Insurance. Company' Policy Number
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
in Fee $
Fee
malty
Ish Deposit -Surety Bond
required
TOTAL: $
eceipt No.
eceived by Date
)rded by
N°
PERMIT VALIDATION .
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246