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1035NOTE: With proper validation this form constitutes an encroachment permit r Ak 0 7'i 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 III DATE: 3 20 1 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION APMOX IOD' NORTH OF I LTersecTiDti OF MONTEZUMA ANS c AI-I-AtyZA (Street address or Description of Location) PURPOSE OF CONSTRUCTION TSTA LL MAILEOX IM Sketch (attach construction plans if appropriate) R/LU DESCRIPTION OF CONSTRUCTION l!0 UMVT MAILBOX hA 1� i4�( 15 T� 6F- �I�STALt,F.� DIMENSION OF INSTALLATION OR REMOVAL APPROX 5' R16A SIZE OF EXCAVATION, IF NEEDED 7-')(Z' SLAB OF PM APPROXIMATE TIME WHEN WORK WILL BEGIN 3-2-3 -9 APPROX - l6Q' M0 ZT1+' DF T-j1)TV-5E0,T)0N OP AAMTMAM AQb CAILQANZA AS MAMED IM TNS FIELD APPROXIMATE TIME OF COMPLETION 4- UP - 91 ESTIMATED CONSTRUCTION COST $ S Z0.1)0 (Including removal of all obstruction, materials, and debris, backfilling, com- Q5i'8"' ��j 0 20 p3 paction and placing permanent resurfacing and/or replacing improvements) �1 �"A H t�-TOTAI^ i 10.00 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 Nt2S . MU 01A I LL G4-300 O BP-irIGIDQ S[o 4- 2-&bS Name of Applicant (please print) Business Address Telephone No. PAUL QUILL 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 �' -3 5' Minor Improvement Permit - Class IV: See attached schedule Inspection Fee Permit Fee Penalty Cash Deposit -Surety Bond if, required TOTAL: $ S I D .•00 Receipt No. Received by Date PERMIT VALIDATION PERMIT NO. 1D313 DATE APPROVED 3-ZO -9 1 EXPIRATION DATE 4 --Ob ` 9 1 DATE ISSUED 3-20^cl 1 By 2&AA1 dministrative Authority Recorded by II TELEPHONE: (619) 564-2246 • e n AY I 6 �, &d t ... NOTE: With proper validation this form: constitutes an " �' a " encroachment permit 4 CITY OF LA QUINTA •APPLICATION FOR- PERMIT $J Y PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) c� x OF THBR For theconstruction 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:, a - Z®" ( Minor Improvement Permit Class IV ' LOCATION OF CONSTRUCTION A PRQX IDD NORTH OF J LrTF_rscCT1aN of: .INO TEZUMA ANr ARQ.At0Z.A (Street address or Description of Location) PURPOSE OF CONSTRUCTION IM'STALL MAILBOX IM Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Ito 1)Rl\T WftmnX IhA1�..F�C1X ,� 7005fAI.L0 APPROX i DO' MOQ TM= OF , TQ.SEC.TIlJN !)P A,AOt�iTF_ZGl/lM DIMENSION OF INSTALLATION OR. REMOVAL 6PPR0) AQb-CAILRAMZ:A A't> M AP..LED �' h 1G N i ISS T�'+-� 'SIZE OF EXCAVATION, IF NEEDED Z' %t 2' SLAB. bF PCC, APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION 4` UP - Cl I ESTIMATED..CONSTRUCTION COST $ 120 •t)Q (Including removal of all obstruction, materials, and debris, backfilling; com- �q q�20 {} _ paction and placing permanent resurfacing and/or replacing improvements) 4r YS s�A�H �f �TOT��9i In consideration of the granting of this permit, the applicant hereby agrees to: ~' t' Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and allf 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 Authofity 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 ! kke.'a-"e 9_1 OtAIILL 54.300- -0b1ZF_GiDK3 S& I- Z&0.S- . Name of•Applicant(please'print) Business Address Telephone No. —PAUL QUILL 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 11,1' Public improvements: 3% of estimated construction costs O Private improvements: 3/0 of estimated construction costs 35 Minor Improvement Permit — Class'IV: See attached schedule' -' Inspection Fee $ PERMIT VALIDATION Permit Fee Ib 10.00 PERMIT NO. Penalty APPROVED 3 t ZD !Cl ` Cash Deposit -Surety Bond' z if required EXPIRATION DATE 4-06 9 1 TOTAL: $• iO.I�U `_ :3-20'ci1 I DATE ISSUED Receipt No. ,By Received by Date` bAdministrative Authority Recorded byTELEPHONE: (619) 564-2246 ny , ••wt'ay+)$Y . �+ `..• PN �_ .ram With proper validation this form: constitutes an " �' a " encroachment permit 4 CITY OF LA QUINTA •APPLICATION FOR- PERMIT $J Y PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) c� x OF THBR For theconstruction 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:, a - Z®" ( Minor Improvement Permit Class IV ' LOCATION OF CONSTRUCTION A PRQX IDD NORTH OF J LrTF_rscCT1aN of: .INO TEZUMA ANr ARQ.At0Z.A (Street address or Description of Location) PURPOSE OF CONSTRUCTION IM'STALL MAILBOX IM Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Ito 1)Rl\T WftmnX IhA1�..F�C1X ,� 7005fAI.L0 APPROX i DO' MOQ TM= OF , TQ.SEC.TIlJN !)P A,AOt�iTF_ZGl/lM DIMENSION OF INSTALLATION OR. REMOVAL 6PPR0) AQb-CAILRAMZ:A A't> M AP..LED �' h 1G N i ISS T�'+-� 'SIZE OF EXCAVATION, IF NEEDED Z' %t 2' SLAB. bF PCC, APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION 4` UP - Cl I ESTIMATED..CONSTRUCTION COST $ 120 •t)Q (Including removal of all obstruction, materials, and debris, backfilling; com- �q q�20 {} _ paction and placing permanent resurfacing and/or replacing improvements) 4r YS s�A�H �f �TOT��9i In consideration of the granting of this permit, the applicant hereby agrees to: ~' t' Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and allf 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 Authofity 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 ! kke.'a-"e 9_1 OtAIILL 54.300- -0b1ZF_GiDK3 S& I- Z&0.S- . Name of•Applicant(please'print) Business Address Telephone No. —PAUL QUILL 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 11,1' Public improvements: 3% of estimated construction costs O Private improvements: 3/0 of estimated construction costs 35 Minor Improvement Permit — Class'IV: See attached schedule' -' Inspection Fee $ PERMIT VALIDATION Permit Fee Ib 10.00 PERMIT NO. Penalty APPROVED 3 t ZD !Cl ` Cash Deposit -Surety Bond' z if required EXPIRATION DATE 4-06 9 1 TOTAL: $• iO.I�U `_ :3-20'ci1 I DATE ISSUED Receipt No. ,By Received by Date` bAdministrative Authority Recorded byTELEPHONE: (619) 564-2246 r. > i � I I , V, � \� --- �A rJ9 Z'i►4 P-�q �? it Ij i 41 i { Ii `7-- 0 NOTE: 4 '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 u �y Subdivision Improvement Permit — Class III DATE: �► — `/ Minor Improvement Permit Class IV LOCATION OF CONSTRUCTIONVedtvlA ©breaon . ev�{�eriyla �i r�- Y�Gt s ` ai�ai✓�sf (Street addressor_ Description of Location) _. PURPOSE OF CONSTRUCT10g ; (�`� ['' Y -h Ir D� Sketch (attach construction plans if appropriate►: s' s C�-� DESCRIPTION OF ONSTRUCTION ur Ct511CYe �h 5 1 , ` DIMENSION OF IN OR REMOVALai�ax. )Clam SIZE OF EXCAVATION, IF NEEDED ` APPROXIMATE TIME WHEN WORK WILL BEGIN ) 09 1 r {' APPROXIMATE TIME OF COMPLETION `Feb 5� 19q ,,ESTIMATED CONSTRUCTION COST $ an,00 (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, defendkand 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 vahen ,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. +� Qua..n f r. .. Signature of Applicant or Agent y V4,- Name of'Appii_cant (please print) : Business Address'--jTelephone No. Name of Contractor,and Job Foreman Business Address Telephone No. Contractor's License No City Business License No. Applicant's Insurance Company y_ Policy Number , f p. ! FEES: Subdivision Improvement Permit — Class I 1_1 Public improvements: 3% of,estimated construction costs Private irnprovements:.3%'of estimated construction costs NO ;..:� lel Minor Improvement Permit — Class IV:' See attached schedule =Inspection Fee -S k PERMIT VALIDATION Permit Fee .. PERMIT NO. Penalty Cash Deposit -Surety Bond ' ' ` DATE APPROVED A T if required _ .4 EXPIRATION DATE M �� TOTAL: $, ED GATE ISSUED a _ Receipt No. •t By Received by _,Date ,Administrative Authority Recorded by '-TELEPHONE: (619) 564.2246 ` / E i r 2'f' T I t l i A 41 ri e t IhiVl P� ®RTA►N..........M>E S SAGE z ;FOR ti i Y AW :'DATE TIME P.M. M OF PHONE-. .. k AREA CODE' NUMBER EXTENSION 1FYiixtY"'"x H.7u"Y 'NY `G" TEIEPHONED�`��x��<� wv;'db {! e'` i'J'� 5»n w'„; yzaPLEASE FALL � � �,Y�� �AM�O�SEEx�YOU� �WIIL�CA CAGAIN � ��� SOW WANT5xT0 SEE YOU RUSH � �� RETUR EDYOUR<CALL� Al aNhyf i"_w �'�^.c"�1 ixi*�'/%SYx F�✓?:SCS c5 K��.. 4� NOTES