Loading...
1066k NOTE: J,,fes r 2. With proper validation,. ' this form constitutes an encroachment permit CITY OFF LA QUINTA ., .APPLICATION FOR PERMIT;;; - ryJ PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) OF For the* the c nstruction 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 n .. yt Ilii . ` �.. �, ' - •. • , •' . -�" •• • �• .. • i 4-17-91` } •Subdivision.lrnprovement Permit = Class IIF.'DATE:'' �` Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION u .51-145 Quint@4 •{ (Street address or Description�of'Location) IV _concret approach a , PURPOSE OF CONSTRUCTION Sketch (attach construction plans if.appropriate) `c , DESCRIPTION OF -CONSTRUCTION concret z DIMENSION OF INSTALLATION OR REMOVAL r. 6x22.' SIZE OF'EXCAVATION,`IF NEEDED �.. , APPROXIMATE TIME WHEN WORK.WILL BEGIN r ,. ".now in process' ' APPROXIMATE TIME OF COMPLETION now ESTIMATED CONSTRUCTION COST $. 100:00 (Including removal of all obstruction, materials, and debris, backfilling, com " pactiori and placing permanent resurfacing and/or replacing improvements) a F . - 'r t R , In,.consideration of the granting of this permit, the applicant hereby agrees to: Indemnify, defend and save We City" its authorized agents, officers,, representatives and employees, harmless.from and against any,'and alk penalties,.liabilities or loss resulting from claims or court action and arising out of any accident, loss or„damage to persons or property; A ,happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. II' Notify the Administrative Authority at least twenty-four, (24) hours in.tadvance of the time when work will be started, n ;, Comply with all applicable City Ordinances, the terms and conditions'of the perrmt�id as I applicable rules -and regulations of the City of . . La Quinta and to pay•for'any additional replacement necessary as the result o hisrk. ` Signature of A Ilcant or A ent S 9 PP 9 s.. Jt „. Me Design P.O. BOX 1480 564—.0229 .,� Name of Applicant (please print) - -•• Business Address ct. Telephone No. 4 same/rf creek la Quints Name of Contractor and Job Foreman, Business Address . Telephone.No. t Contractor's License.No. City Business License'No.., • - t Applicant's Insurance Company Policy Number 00518 i0. 1409,04"0-91 '10 } FEES:,. Subdivision Improvement Permit — Class III W CASH i TOTAL i •10.00 Public improvements: 3% of estimated construction,costs:•I- i ` • Private improvements: 3% of estimated construction costs (a 6 6 Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ 20.00 20.00 Permit Fee Penalty Cash Deposit -Surety Bond if.. required 30.00 TOTAL: $ Receipt No. Received by Date Recorded by PERMIT VALIDATION iu PERMIT NO. 1n66 DATE APPROVED 4-17-91 EXPIRATION DATE 4-19-91 4-17-91 DATE�t D By Administrative Authority x. TELEPHONE: (619) 564-2246 'fie. • j.., , NOTE: 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 4-1791 Subdivision Improvement Permit — Class I II DATE:' Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 51-145 Quintlo (Street address or Description of Location) concret approach ,PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION concret -DIMENSION OF INSTALLATION OR REMOVAL . 6x22' SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN now in process APPROXIMATE TIME OF COMPLETION now, ESTIMATED CONSTRUCTION COST $ 100.00 (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, -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�an qil applicable rules.and regulations of the City of La Quinta and to pay for any additional replacement necessary as the result4tHis.work. Signature of Applicant or Agent Mc Whirther Design P.O. BOX 1480 564-0279 Name of.Applicant (please print) Business Address ' Telephone No. same/rj creek la Quinta 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 io 005 MSH 10 1409 04 -17-91 10 :. ASH i TOTAL 1 . 30.00 Public improvements: 30/6:0f estimated construction costs ; Private improvements: 3% of estimated construction costs 1 066 Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ 20.00 PERMIT VALIDATION' 20.00 10 Permit Fee PERMIT NO. 1066 Penalty Cash -Deposit -Surety Bond if,required 30.00 TOTAL: $ Receipt No Received by Recorded by Date 4-17-91 DATE APPROVED EXPIRATION DATE 4-19-91 DATE,ISS0 • D " By -y" Administrative Authority C,. TELEPHONE: (619) 564-2246 NOTE: With proper-v_aikW6011z. • _ this form constman-an yr 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,..wstec nquts. and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS /� Subdivision Improvement Permit — Class III DATE: k0((, �� l / Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION yS C `=ao-P� C/%t-e r (Street address or Cucnption of LocoWni PURPOSE OF CYNS RUCTION Lo�c.0 ' " P��' Sk ch (attach construction plans if appropria) DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF„EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COSTS (including removal of all obstruction, materials, and debris, bar+cfilling, com- paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit, the applicant hereby agreesilto: Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any end all pensities, 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 twentyfour 1241 hours in advance of the time when.work win be started. ' Comply vnth all applicable City Ordinances, the terms and conditions of the pe all applicable rules and regulation of the City of 4 La Quints and to pay for any additional replacement necaory as the Of Signature of.Applicant or Agent c CIrJ111f4l !� Stct�1 �-eY � €C) Name of Applicant (plea a print) Business Address Telephone No. Name of Cont�d Job Foreman _ Business Address Telephone No. Contractor's License No. City Business, License No. Applicant's Insurance Company Policy Number FEES: Subdivision Imorovemerit Permit —.Class III Public improvements: 3% of estimated construction costs . Private improvements: 3% of estimated construction costs *j0 Minor lmorovement Permit —Class IV. See attached schedule Inspection Fee S `PERMIT VALIDATION Permit Fee PERMIT NO. Penalty Cash Oeposit•Stirety Bond, , DATE APPROVED' if required EXPIRATION DATE TOTAL: $ DATE ISSUED Receipt No. By Received by Date Administrative Authority Recorded by TELEPHONE: W19) 564.2246 tri NOTE:. With proper validation •this form constitutes an `• ' � •' �+ '' CITY' F.' encroachment permit'. O LA aQUINTA x. APPLICATION FOR PERMIT • ` ' PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) r '•>: t For the construction of -'public or, private curbs, driveways, -pavements, sidewalks, parking lots, sewers,,waterimains ' and other like public works' improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS-' 4-17-91 ' Subdivision Improvement Permit — Class III C s DATE:. -t+r Minor Improvement Permit Class IV ' . 1517.145•Quinto , _. . r ,f LOCATION OF CONSTRUCTION • (Street address or Description of Location)' y concret approach k PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION concret tet. r DIMENSION OF INSTALLATION OR REMOVAL 6x22' SIZE OF EXCAVATION; IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN' ` now in process' _ f• APPROXIMATE TIME OF COMPLETION now . ! } , ESTIMATED CONSTRUCTION COST $ 100.001-1 ' (Including removal of all obstruction, materials, and debris, backfilling, com•' ^' i • ; ' paction and placing permanent resurfacing and/or replacing improvements) t "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 ;i proxirrate result Iof any work undertaken under the permit granted pursuant to this application. s • Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will'be started.Ir 0 = Comply with .11 applicable City Ordinances, the terms and conditions of the perm' J all applicable rules and regulations of the City of La Quints and to pay for any additional replacement necessaryas the resul this r Signature of Applicant or Agent • y ^� 4 a' Mc Whir ther Design • P.O. 'BOX. 1480^ 564-0279 Name of Applicant (please print) Business Address t Telephone No. , same/rj creek la Quinta` + ''• r Name of Contractor and Job Foreman Business Address.. *, Telephone No. - 1 Contractor's License No. .. City Business License No. t$s� - Applicant's Insurance Company -; Policy Number FEES: Subdivision Improvement Permit - Cless'lll r 1005182 OS ASH 1 TDTAL i-17-930.00 ' 10,x. Y.: JPublic improvements: 3% of estimated construction costs ���' �• • ,. Private improvements: 3% of estimated construc4ion costs r 1066 4 r Minor Improvement Permit —Class IV:" attached schedule ^� t: r. x ;Inspection Fee € $ 20.00 r t'' } I ` PERMIT VALIDATION f" 10.00 Permit Fee. 'PERMIT N0. t_ 1 Penalty ! , F 4-17-91 a Cash Deposit -Surety Bond ' ' ` ,DATE APPROVED _ if required A • EXPIRATION DATE. 4-19^91 I 30.00* 4-17-91 "TOTAL: $ ! YDAT D w; Receipt No. ♦A +' Received by R Date s By', Administrative Authority ' Recorded by TELEPHONE: (619) 5.64-2246 r .