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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)
OMC, -N-IF 0U9S J? (COAD X59M IT`
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
V
DATE
i5 -?2-q 0
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MQV7- �ZOVIIP94ZUT
DESCRIPTION OF CONSTRUCTION D 6 DO 7- 17-1�
DIMENSION OF INSTALLATION OR REMOVAL ID'S ))(12"g)
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
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:
AUS. 47 NY5
a
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 propea rty
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.
� Qwh - v i
Signature of Appli t nt or A� nt
UVEVO 76- 511 P-01 �T2V CLIAB Z.U. ;5uS-1-775
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
QAJ r- 1(_f.
Contractor's License No.
City Business License No.
®AI 1= I I -S OAJ F / L E'
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:
1191,90
$ /99.00
Receipt No.
Received by Date
PERMIT NO
1 037
PERMIT VALIDATION
1,03-7
DATE APPROVED 3'Z-2- -Cl
EXPIRATION DATE 7 -ZS -C
DATE ISSUED Z
By o
A ministrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
n�
NOTE:
(With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION .FOR' PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
otic 7071? 0VCES1ZE LOAD PFeMtT
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
F.
Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION M OVE KQVIPAAENT Sketch (attach construction plans if appropriate) ,
'DESCRIPTION OF CONSTRUCTION DCA HOZ ��
-AA VL . �.oOT�
AUL
'
DIMENSION OF INSTALLATION OR REMOVAL � Q'14 I I � Ip �� � WV4 � �1C��T01�-) `TD CIS Z•.liLi li`S.'.
10 0 1✓95
1-Aul '-Dkli'..-25 .I
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
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.
Coniply-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.
MCCA.
Signature of.Appli nt•or Agent
IVtIt V0 72) 25+ i CVU T211 CL U.B.L7. 3�I - t�78
Name of Applicant• (please print) Business Address Telephone No.
Name.of Contractor and Job Foreman Business Address Telephone No.
6AJ PdL t .
Contractor's License'No. City Business License No.
OAJ 'F I L:
Applicant's Insurance Company Policy Number'
•r
FEES: Subdivision Improvement Permit'- Class III
Public improvements: 3% of estimated construction costs _.
Private improvements. 3% of estimated construction costs .0
37,
Minor.Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty,
Cash Deposit -Surety Bond
if.required
TOTAL: $
Receipt No.
Received by Date
Recorded by
r
PERMIT VALIDATION
PERMIT N0. W 3 %
DATE APPROVED 3-1 Z 2 _C1
Cl i
EXPIRATION DATE 3
,r•:�:i two.
DATE ISSUED a a
By–
Administrative Authority
TELEPHONE: (619) 564-2246
VOTE:,
Nith proper validation
this form constitutes an
encroachment permit
CITY OF LA GUINTA
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
��? I Subdivision Improvement Permit — Class 111"
DATE: ✓ 1 - Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street addressor Description of Location)
PURPOSE OF CONSTRUCTION 7�4Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 120
DIMENSION OF ! STALLATION OR REMOVAL
SIZE OF EXCAVATION IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN, ,
-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)
1n consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend arid -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 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.
Vn O)a
Signature of Ap li nt or nt -
Nuevo'Engineering, Inc., 79-811 Country C1ub,'Bermuda Dunes 619-345-1778
Name of Applicant (please print) Business Address Telephone No.
Name of Contra nd Job Foreman
n)I di 1,P
Contractor's License No.
Business Addressp�� . lephone No. "
LJ/ l �Q
City Business, License No.
Applic'nt'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 lr
Mnspection Fee
Fee ,
nasty
ish Deposit -Surety Bond
required
TOTAL: $
No.
by Date
I by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (61%564-2246