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=With proper validation �' � , .t � r •' 04,
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this form constitutes "am A r -• �� �• p
+, : ;CITY' OF L'A aQUINTA R , •'.. t
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encroachment permit ,. ,
"'APPL'ICATION FOR PERMIT
. PUBLIC' WORKS CONSTRUCTION (ENCROACHMENT)
OF. TK8
�• y
•' For the con'st'ruction 'of public or, private curbs, driveways; pavement s,.sIidewalks, parking lotts,`sewers, water'mains
r
' . and other like public works improvements .in connection with MINOR IMPROVEMENTS andtAPPROVED SUBDIVISIONS
• ,� Subdivision Improvement Permit= Class III
Janaury 4 1991 -� .. ' ti
' • . DATE: 1 ' . Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION•` ' 'TR'..25237 ` Rnncth` dr.adi n6 ''� •' '' '
_ THIS PERMIT y 5UPERCEDES ROUGH GRADING . PERMIT `4 `0796.
(Street address or Description of Location)" + - - , '. r
PURPOSE OF CONSTRUCTION• Sketch �(aftach construction plans,if appropriate)
` DESCRIPTION OF CONSTRUCTION`; -'
DIMENSION OF INSTALLATION OR REMOVAL
. SIZE OF'EXCAVATION IF'NEEDED•
APPROXIMATE TIME WHEN.WORK WILL'BEGIN
------------
APPROXIMATE TIME OF,.COMPLETION ,,. 't a
r'
_r �« f
ESTIMATED CONSTRUCTION COST'$ y `� « '.-, ••
(Including removah ali'ofistruction, materials ;:and debris; backfilling; com*:
paction and placing permanent •resurfacing' and/or replaci=g=improvements)..
In consideration of 'the granting of,this•permit, the'.applicant hereby. agr`eessto:'• "•� • ' ,�,
,: �`', _
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-andarising out of any -accident, loss or damage, tofpersons or, property
happening or occurring as a;proxi' to result -,of any work undertaken under the permit granted pursuant o this application. •,{
,
Notify. the Administrative •Authority at least twenty-four A(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 regulation"s'of the Cify of.
La Quintanand to pay for any additional replacement necessary as the result of this work:
• - i ' Signature,of;Applicant'orAgent-
_
01hio Citizens- ;Investment -Corp PO °Box,,\i80 La''•Quinta ' 5'642155
-
_,
Name of Applicant (please print)'t Business Address-, Telephone No.
JHT.Construct16n"-393 W: Athol �St..� •ull' San Bernardino"92401'714/885-8.382
Name of Contractor and Job Foreman .Business Address"' r',a w'Tel'ephone No. '
'
A563749-
Contractor's
563749 Contractor's License No. City Business.License No..
Cigna 1r. ,Fs MFC D167.22182. & G13114149 '
Applicant's Insurance.Company' ; - . , '• Policy Number
FEES: Subdivision Improvemenf Permit —.,,Class Illy
Public improvements: 3% of estimated construction costs, •4+
tiPrivate. improvements: ,Ao of,estimated'construction costs" . "t ,
Minor Improvement Permit — Class IV: See'attached schedule
Fee
Inspection paid permit ' 0796' '
P $ - PERMIT VALIDATION '
Permit Fee
Penalty -
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No. '
Received by' Date
Recorded by '
PERMIT NO. 097/3
-
• •,• r
. DATE APPROVED' �4�9 ' 1 1 r
EXPIRATION DATE, 1 A 1
DATE ISSUED '.114/91'
By
` . Administrative Authority
TELEPHONE: (619) 564-2246
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NOTE:
With proper validatioii —
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 III
DATE: Janaury 4, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION TR .25237 RourTh aradina
THIS PEPOIT SUPERCEDES ROUGH GRADING PERMIT 4 0796
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
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 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., - t it
Signature of Applicant or Agent
Olnio Citizens Investment Corp PO Bok 780 La Quinta 564-2155
Name of Applicant (please print) Business Address Telephone No.
JHT Construction 393 W. Athol St. # 9 San Bernardino 92401 77.4/885-8382
Name of Contractor and Job Foreman Business Address Telephone No.
A563749
Contractor's License No. City Business License No.
Cigna MFC D16722182 & G13114149
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
T2 r�
Minor Improvement Permit — Class IV: See attached schedule �� '
Inspection Fee $. Paid Permit 0796
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 0973
DATE APPROVED 1/4/91 ;
-EXPIRATION DATE 3�3� ��•
DATE ISSUED 1/4/91'
By.
Administrative Authority
TELEPHONE: (619) 564-2246