0971S�
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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
Subdivision Improvement Permit — Class II I
DATE: 1-3-9d) Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTIONMOVP ecrtainc Sketch (attach construction plans if appropriate)
'DESCRIPTION OF CONSTRUCTION barber arpen 50th & Jefferson west to
washington north to miles.
.DIMENSION OF INSTALLATION OR REMOVAL 10 6 wide,
arPan wt„
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ haul date 1-3-91
(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. ,
Signature of Applicant or Agent
.na.ssey sand &rock p.o. box 14050 halm iie!
Name of Applicant (please print) Business Address
yert ca.-92255-4(yA
Telephone No.
Name -of Contractor and Job Foreman Business Address Telephone No.'
on file on file
Contractor's License No. City Business License No.
on file on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
.Public improvements: 31/6 -of estimated construction costs : 4w5iWASW P �03-91 i 4.0Ql0
Private improvements: 3% of estimated construction costs' ' U R
Minor Improvement Permit —Class IV: See attached schedule N2 Y
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required.
TOTAL: $ in -no
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION .
PERMIT N0:
0971
DATE APPROVED
EXPIRATION DATE 1-3--91
i
DATE IISSU"E�D'
It -1 91 t
gy .11';V.,(/.�lr,flll.__,.1�f1_,�l.�J.-
f
Administrative Authority
TELEPHONE: (619) 564-2246
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NOTE:"
With proper validation j 2
this form constitutes an
CITY OF LA QUINTA
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 I I I
DATE: 1-3-9@ Minor improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTIONmove ectuin- Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION barber green 50th & Jefferson west to
washington north to miles
DIMENSION OF INSTALLATION OR REMOVAL 10 6 wide
grpen wt..
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ halal date 1-3-91
(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. ,
ssev sand &rock
Name of Applicant (please print)
.o. box 14050
Signature of Applicantor
lm desert ca 92255-4
Business Address
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
on f ile
Contractor's License No.
on file
City Business License No.
on file on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs 1Fi%SW i139.')Afff?Li 103-91 t�+0010
Private improvements: 3% of estimated construction costs +� Drip
Minor Improvement Permit — Class IV: See attached scheduleV� r, `
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
10.00
$ 10.00
Date
PERMIT VALIDATION
PERMIT NO. 0971
DATE APPROVED 1-3-91
EXPIRATION DATE 1-3-91 -
DATE ISSUED T�14•-3-91
gyr,�YO.,%/,�I•t _ ...li' �I,/.le1i'YVIA"A�/t�.,_
Administrative Authority
TELEPHONE: (619) 564-2246
. . 2 /fit ,1 ,• ,
lith pwaf ualldiiildR i ; �..,
its form constitutes an
icroachment permit CITY OP ' LA CiU1NTA
APPLICATION FOR, PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) .
pA 71It ,
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
ATE: Minor Improvement Permit Class IV
,OCATION OF CONSTRUCTION
Street address or Description of Location)
RPOSE OF CONS •'Sketch (attach construction plans if appropriate)
)tMENSION 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 end"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 (241 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.
/f Signature of Applicar Agent
U TRUCTION
of Applicant (please print)l
Business Address o
l�
iName
'Name of Contractor and Jo For an
Business Address Telep ne
Contractor's License
City Business License No
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
colt:
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
`;r,
PERMIT VALIDATION
Permit Fee
PERMIT NO.
Cash Deposit -Surety Bond
",= ;- ;: DATE APPROVED
if required
EXPIRATION DATE
TOTALt 11111''
DATR MUg4
hecelpt No..,
RiicAluad by D.to
Adminlstrative Authofl
Recorded by
_ .. TELEPHQNE; (0191964,ZZ46