1020r w
NOTE:
V With proper validation''
this form constitutes an
I ' encroachment permit CITY OF , LA QUINTA
APPLICATION -FOR PERMIT
44 f
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
'SOF THBR
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
y
f FebrAr 26, 199.1 _
DATE: Minor Improvement Permit Class IV
• LOCATION,OF CONSTRUCTION.
s/w corner, Washington and Arvenue,•50, '
(Street address or Description of Location) "
. PURPOSE OF CONSTRUCTION , place 4 — 4" QVC Sketch (attach construction plans if appropriate)
f 'conduits - �'. .
DESCRIPTION OF CONSTRUCTION nlaCft' 4-4" 'PVC
conduitA per'GTE permit'0892
`t all conditions of permit •0892
DIMENSION OF INSTALLATION OR REMOVAL 78 1 X2 1.4 shall apply to this permit
x SIZE OF�EXCAVATION, IF,NEEDED 4
}
y' ;APPROXIMATE TIME WHEN WORK WILL BEGIN 3!4/81
APPROXIMATE TIME OF COMPLETION 3/8/91
ESTIMATED CONSTRUCTION COST $ 000 «% `
=(Includi6d removal '6f all obstruction, materials, and debris, backfilling, com-
paction and placing.permanent resurfacing and/or replacing improvements).
In consid6rati6n' of the granting of this permit, the applicant hereby agrees to:
Indemn6,•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.
. ' ` �' 1 , ... � 1 " - Y 't '(Jj� }(�/���\� (1,+` z;. �/l//�/J,//`�".yf Y Y � eI � • , ' V
"� Signatu a of App), ant or Agent
Iierman.'Weissker, Inc. 2820 Industrial Dr. Bloomington, CA.714-87:7-2470.
` Name of Applicant (please print) Business Address ;,,,. T61ephone No:
Gary Wisser ' s ame
Name of Contractor.and Job Foreman Business Address Telephone No.,
183556 `.1661
'Contractor's License No.' City Business License,No.
Applicant's Insurance Company " " , Policy Number
FEES: , Subdivision Improvement Permit — Class I I I
,_r 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
$ 80.00
TOTAL: $ 80.00
Receipt No. ✓q0-3 z
Received by A � Date sA4,
..,.$�r�'r,9
iv1r84 000
i20
Z - ,
PERMIT VALIDATION
4 '
PERMIT NO. 1020
DATE APPROVED 2/26/91
EXPIRATION DATE 6/31/91
DATE ISSUED /2/26/91
I f
By
Administrative Authority
Recorded by tp 11 TELEPHONE: (619) 564-2246
NOTE:
With propervalidation
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
FSubdivision Improvement Permit — Class III
DATE ebruary 26, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION s/W Corner, Washington and Avenue 50
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Place 4 - 4" PVC
conduits
DESCRIPTION OF CONSTRUCTION glace 4-4" PVC
conduits
DIMENSION OF INSTALLATION OR REMOVAL 781x214
SIZE OF EXCAVATION, IF NEEDED
'X APPROXIMATE TIME WHEN WORK WILL BEGIN 3/4/81 "
Sketch (attach construction plans if appropriate)
per GTE permit
all conditions
shall apply.to
0892
of permit 0892
this. permit
APPROXIMATE TIME OF COMPLETION 3/8/91
ESTIMATED CONSTRUCTION COST $ 3,000
(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 anyand all
I
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. r, '
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—App.11pant or Agent
Herman Weissker, Inc. 2820 Industrial Dr. Bloomington, CA 714=877-2470
Name of Applicant (please print) Business Address _ Telephone No.
Gary Wisser s ame
Name of.Contractor and Job Foreman Business Address Telephone No.
183556 1661
Contractor's License No. City,Business License -No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III 017.81 10. T00'.03—of-91
Yn 80, OP
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1020
UTAL
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 80.00 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if.required
TOTAL: $
80.00 ;. A401,
Receipt No.✓.�QO-3
Received by T��,ti �;, Date -
Recorded by
PERMIT NO.
PERMIT VALIDATION
1020
DATE APPROVED
2/26/91
EXPIRATION DATE 6/31/91
'` 2/26/91 ,
DATE ISSUED i
By
Administrative Authority
TELEPHONE: (619) 564-2246