0984NOTE:.'
With proper validation
this form constitutes an
encroachment permit
CITY OF LA •OUINTA
APPLICATION FOR PERMIT.
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
'0A1rz_TKIY 0VE1251ZE LOAD PeF-Ml•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
r
Subdivision Improvement Permit — Class III
DATE: I� 1�. - q Minor Improvement Permit Class IV
:LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE EQIAIPM E1�IT Sketch (attach construction plans if appropriate)
DESCRIPTIONOFCONSTRUCTION (NATER -TQVVER TOW, 'WATER -COWER
in , WIDE ALL ELSE L_EG A �. TUIiU ROIAT E : OPER E60 N
CA 1 u A A 1-I U A 'TO' tE,K M 1n1) A S
DIMENSION OF INSTALLATION OR REMOVAL TD S Z L In_) AS 14 1 1J&,TD1`1 "TCU
02.1 "TY L 11ti4 1 TS
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN"`
APPROXIMATE TIME'OF COMPLETION
ESTIMATED CONSTRUCTION COST $ -TO (,(j. L/I"r jy 1 _) S - G �
(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.
7 -AOM Rd, 1 M i4 S 5 Ery
Name of Applicant (please print)
Signature of Applicant or Agent
P0, 80X 1410 50 - '•PD
Business Address
Telephone No. .:•
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No..
e5ti ri4F__ QA/ >'11-6
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 $
Permit Fee
• Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ D O
• Receipt No.
.Received by Date
Recorded by`
17 3H
T2 0 99-R
it :�
PERMIT VALIDATION
PERMIT NO. 0 91y IV
DATE APPROVED
.EXPIRATION DATE
DATE ISSUED "��%f s 91
IOV
Administrative Authority
TELEPHONE: (619) 564-2246
t
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NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
G�ll1 M 1Y 0Vr!tZcAZ9. LOAD F`EP-MIT
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
t -)s -q1
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 102111L FOUIPM EWT
DESCRIPTION OF CONSTRUCTION VVA` E f� _T(2 W F R
111 t VAII I)F" A1_ l_ V 1-e�F
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, 1F NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit- Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
TCW VVXTEW, _POWER
CIA "Ii A t'WA _Vo bEtiVilfel
l 61D
A5
TO
0171 LIM I_Tc�
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ �,I '� W DAT1F 1 _ ) 5 - q
(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.
Name of Applicant (please print)
Signature of Applicant or Agent
Business Address
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
^A/ x -j/ X
Contractor's License No.
4W F/L_4'
City Business License No.
6 A/ '! 1 r QA A7)1- 5
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit - Class I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit - Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
/4.0X-)
$ 119. /).)
Received by Date
0, 'C %g3i%PAt V—v� �0a06,)
PERMIT VALIDATION
PERMIT NO. �% 9
DATE APPROVED
EXPIRATION DATE Z 5 9Z
DATE ISSUED �1` %5-- 9/
W Administrative Authority
Recorded by 11 'TELEPHONE: (619) 564-2246
TOTE:�
JI{Ii
its form constitutes an CITY:OF'! LA' Ql�{NTA►
icroachmerlt permit v
APPLICATION_ FOR, PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
' `•�.� •t, �•' . , r I pp 911®
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
;:
TATE: Minor Improvement Permit Class IV
.00ATION OF CONSTRUCTION
Street address or Description of Location)
'URPOSE OF CONSTRUCTION .'Sketch (attach construction plans if appropriate)
)ESCRIPTION F CONST- U TIQN��'
)IMENSION OF INSTALLATION OR REMOVAL
1 T
512E OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN -C
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 (241 hours In advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms a4'conditions of the permit and all applicable rules and regulations of the City of
La Oulnta and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agen
Name of Applicant 4ease print) Business Address le hone No
Name of Contractor and Job foreman Business Address Telephone N
Contractor's Licen a No. City Business License N .
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class 111
Public improvements: 3% of estimated construction costs...;;
Private improvements; 3% of eatimatod construction co u No
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
Permit Fee PERMIT NO.
Cash Deposit -Surety Bond i � OATE APPROVED
if required = ~`' EXPIRATION DATE
TOTAI.i QAT9 ISSUED±' r -
Ncelpt No. }
AecAlU�d by .Data f�dlnlnlstrllslvp Autnorll
Recorded by TELEPHON;1�191664•�ZA6