1017NOTE: �.. .
jWith'proper'validation '
-{ this form constitutes an
encroachment permit CITY OF LA QUINTA
APPLICATION" FOR . PERMIT
r u4 PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)�� ' ,.Sww� •'
o 0F.TRB� ' f
For the construction of'-public.'or , private curbs, 'driveways, pavements; -sidewalks, parking lots; sewers', ;water mains �r
,.and other,like'public works improveme_nts,in connection with MINOR IMPROVEMENTS and APPROVED'SUBDIVISIONS "
Subdivision Improvement Permit —"Class-III
DATE."� Minor Improvement Permit Class IV
`
LOCATIONOF CONSTRUCTION `7 9.5�- F_ISEkU A+0W ER - ►.
ti.
', ' • ,' L (Street address or Description of ,Location) 3 `�
it
'T�Q1�tWAV A',PvAG'}i
PURPOSE OF CONSTRUCTION Sketct`(attach�cons`tructlon plans If appropriate► r•, ,
. r .3 w . , r, • -w , •rtti -.-t ! T ,.�- }. rT.. "'.i' r : , r $' PE
_:rs r�, - - ..,�,
DESCRIPTION.OF CONSTRUCTIONT j� �% %���
•'� - . :a .t , _ .a t A•{
"1��� {^'' j�U Irv.f�.;�+, G+. ) I • _ ' 'r. „'}p - .•
DIMENSION OF. INSTALLATION OR REMOVAL ZO"0)101-° • ° ! u' i"
'`y _ C f +1 r. 'n , 1 r ' } •` f^ . ` t fr a • !'4•Y•, r -i
SIZE OF EXCAVATION, IF NEEDED +
,APPROXIMATE TIME WHEN WORK WILL BEGIN 5 ft �TDTAtW � 0. 0
—'APPROXIMATE TIME OF COMPLETION
�r ESTIMATED CONSTRUCTION COST $ y ,
(Including removal,of all obstruction, materials, and debris,' backfilling, com-'
"• '0action and placing,.permanent resurfacing•and/or replacing improvements) {
'
id-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 • 4A
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. _ t
Notify the' Administrative Authority at least twenty-four, (24) hours in advance of' the time when work'will be started. r
` Comply with all applicable iCity 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 : ,
1A0CuwQ .,canP P.n. r30A Say. .LA Gt�4l,�'"A soy_ q77.•
•Name of Applicant (please,print) Business Address Telephone;No. 4
.` Name of Contractor�and Job Foreman Business Address a `' ' .' Telephone No. r
Contractor's License No. City, Business License No: y
gApplicant's Insurance Company Policy Number,' ;
FEES: Subdivision Improvement Permit — Class
'Public improvements: 3% of estimated construction costs
Private improvements: 3/0 of estimated construction costs �j r j
• u 1 V,1'
`t
} ¢ e
Minor Improvement Permit — Class IV: See attached schedule ` ,ro "�'•
�,''�• Inspection Fee '7' $ ZO' 0� x ~PERMIT VALIDATION "!}
Permit Fee '
;,. PERMIT NO
Penalty,
'C?
/
kCash'Deposit-Sueety:Bond DATE APPROVED-`
�if,required Y. EXPIRATION.DATE,
TOTAL: $ DATE ISSUED !J q
ReceiptNo.By-
7 {
rReceived. by ' ' Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
r
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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)
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 •111
DATE: - ~ q, Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S S S E K6 E k) R 0 W ER
(Street address or Description of Location)
D20 E w AU R PP�I'Mt 1 , p ppropr.iate).
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if a
DESCRIPTION OF CONSTRUCTION PERUYEL51 D6 CCmk"Ty '
'STD MD Z07
ATTA Cii• E D
DIMENSION OF INSTALLATION OR REMOVAL �0IflE
SIZE OF EXCAVATION, IF NEEDED 22 p
APPROXIMATE TIME WHEN WORK WILL BEGIN5i8cA
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
swwork.
Signature of Applicant or Agent
SUA3Uf1WO Co12P go, BOA Sbq LA OfAWA 5'&4/ - g177
Name of Applicant (please print) Business Address Telephone No.
OUJAX-1Z ) F V /LDF/Z
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
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
7t7 Y?0
Inspection Fee $ '
Pormit Foo /0.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$ 30.00
'Receipt No.
Received by Date
Recorded by
1017
PERMIT VALIDATION
PERMIT NO. 10/7
DATE APPROVED 2 _1Z5 _ (7 1
EXPIRATION DATE �+ q
DATE ISSUED R 1
By
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper. validation
this form constitutes an'CITY OF LA QUINTA .
encroachment permit •' s4
APPLICATION FOR 'PERMIT
PUBLIC, WORKS_ CONSTRUCTION (ENCROACHMENT)c
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 lmprovementPermit — Class IIII
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION' 4y4 `Sketch (attach construction plans if appropriate)^
rCom% ff�
DESCRIPTION OF CONSTRUCTION,
DIMENSION OF INSTALLATION OR.REMOVAL"
SIZE OF EXCAVATION, IF NEEDED.- t 3
APPROXIMATE TIME WHEN WORK WILL BEGINT�y 4 Y
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $t zoo
f ,
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and 'placing permanent'resurfacing and/or replacing improvements)., r _
'In consideration of the granting of„this permit, the'applicani Hereby agrees to: L
v 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
'jU,ve&Wzj moo/ ^ S�'1-yg77'
Name of Applicant'(please print) r '. Business Address w. Telephone No.ZZZ '.
L4,1 L-1�
ame of Contrac r. and Job Foreman Business Address Telephone No.
Contractor's- License No. - City Business. License No.
s
Applicant's Insurance, Company ti 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, VALIDATION
Permit Fee PERMIT NO.
Penalty
I
Cash Deposit -Surety Bond . r DATE APPROVED
` if required EXPI RATION{DATE
TOTAL:
DATE ISSUED
.Receipt No. '
t By
Received by Date Administrative Authority
Recorded by l _ TELEPHONE:: (61,9)564-2246 '