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1036a NOTE: With proper validation this form constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) o&)F —MI? vN,fi2S1Z4e_ C.0109L'>I;WeAfI r 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: LOCATION OF CONSTRUCTION Subdivision Improvement Permit —Class III Minor Improvement Permit Class IV (Street address or Description of Location) PURPOSE OF CONSTRUCTION MOVE TI -©U I PME U7 Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION &Z3 SC?_APCK DIMENSION OF INSTALLATION OR REMOVAL 1 LI H )O ' /Ai SIZE OF EXCAVATION, IF NEEDED RAV L ROUTC .AVS 41 N/5 6N A 0541 AIC -ii ON ?"O GIT Y LIKATS APPROXIMATE TIME WHEN WORK WILL BEGIN 4AUL DATIL APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris, backfilling, com y ' O1��g C SHOibT�TAL` —91 2o.414 paction and placing permanent resurfacing and/or replacing improvements) 1 1 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 ApvlicantAgent 13U F.VO EI.y_-31 k)EE 211JG iii • Oil CDUtiI"f N C �, P -5.D, 3�I S-177 g Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No.. b kJ F 1 LE Contractor's License No. City Business License No. ON F: ILE Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class 111 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 10 , 0 t,7 Penalty f Cash Deposit -Surety Bond if required TOTAL: $ 10.00 Receipt No. Received by Date Recorded by 1036 PERMIT VALIDATION PERMIT NO. ) �� DATE APPROVED EXPIRATION DATE ` 2 5 — q DATE ISSUED D"27' °l 1 By— '76 2�L 11�� Administrative Authority TELEPHONE: (619) 564-2246 ` ... ��, . �h� .. .. .. _ �.., ... ... �. �,.� „ r . � _'-i� r ._.. x'71 S -.'i .tr*.t, R_ ",, , s.. �, .. ,� R; { r ... i � � .r � i/ r , r , � _ _. �~ � t 4� � 1� r��i r _� � ti J � r I I 1 ` � r . �` i �� � l NOTE: With proper validation this -Form constitutes an encroachment permit CITY OF. LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS- CONSTRUCTION (ENCROACHMENT) 0 AjF_ —roc'. j? 0 (164S /Z 4E 40,0V� I;WZAfl 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 f I I DATE. 5- ZZ.- 9 1 Minor Improvement Permit Class,IV LOCATION OF CONSTRUCTION '(Street address or Description of Location) PURPOSE OF CONSTRUCTION MOVE EQUIRfACAYT Sketch (attach construction plans if appropriat6) 4AV L_ ROVTV- DESCRIPTION OF CONSTRUCTION AVE .141 N/5 17" TVAJ -TO t /Ty, Ak3 A bV4) IVC -7 DIMENSION OF INSTALLATION OR REMOVAL 10 HI 101 thi L' KA 175 I'1 U 1 00 0. L 51C SIZE OF EXCAVATION, IF NEEDED ty APPROXIMATE TIME WHEN WORK WILL BEGIN PAUL TATE 7;5 Lc5 I APPROXIMATE TIME OF.COMPLETION ESTIMATED CONSTRUCTION COST $ removal I of all obstruction materials, and debris, backfilling, com- -'0? i82C (including APHOM Lwgi 20 0p3 2'_. 00, pactibn and placing permanent resurfacing and/or replacing improvements) In consider ation 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 tl,' penalties, liabilities or loss resulting from laimi or court action and arising out of any accident, losi 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 Au ? thority 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. LT 4 Signature of Ap'glicant Q �kgent KA) Evo. F� Q -,C11 UEF-RIMG _761-1311- COU0164 CLVE>, jt,,D.345-17779. -Name of Applica'n't (please 'print) Business Address Telephone No. 'Name of Contractor and Job, Foreman Business Address Telephone No. 6 kj, F ILE Contractor's License No. ,,e City Busiriesi'License No. Oro FlUIE ,Applicant's Insurance Company Policy Number C ``FEES: . Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs. Private improvements: 3% of estimated construction costs 1 036 Minor Improvement Permit — Class IV: See attached schedule" -Inspection Fee $ PERMIT VALIDATION Wrmit Fee 10100 PERMIT NO. Penalty DATE APPROVED q I Cash Deposit -Surety Bond ifrequiredEXPIRATION DATE I - 2_G -_9 TOTAL: 10 ..00I. DATE ISSUED Receipt No. A By— IA41 Received by Date Administrative Authority i Record by JELEPHONEi (619),564-2246 ";4 VOTE: Nith proper 'validation :his 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 Subdivision Improvement Permit — Class III DATE: ( ` - Minor Improvement•Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) , DESCRIPTION OF CONSTRUCTION y� 13 . Dw , DIMENSION OF INSTALLATION OR REMOVAL wa, SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION - ESTIMATED CONSTRUCTION COST $ 3/251 T -' (Including removal of all obstruction; materials, and debs•is, 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. ' I Notify the Administrative Authority at least twenty-four 1241 hours in advance of the time when work will be started. Comply with aR applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of La Quints and to pay for any additional replacement necessary as the result of this work. Signature of Applica r Age t Nuevo Engineering, Inc. 79-811 Country Club, Bermuda Dunes 619-345-1778 Name of Applicant (please print) Business Address Telephone No. Name of Contra rand Job Foreman Business Address Telephone No. Contractor's License o. City Business License o. t Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class 111 Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs N? *0 Minor Improvement Permit — Class IV: `See attached schedule jv ' nspection Fee $ 'ermit Fee 'enalty :ash Deposit -Surety Bond , I required TOTAL: $ leceipt No. leceived by Date lecorded by PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE, DATE ISSUED By . Administrative Authority TELEPHONE: (619) 564-2246