1079NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
(DQF- TRAP OUEiZSIZE LOAD PERM 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
DATE: 4-- 24 _ q l
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit —Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVF— EQUIP. Sketch (attach construction plans if appropriate)
DESCRIPTION OFCONSTRUCTION R "AOL ROUTE
UJA5RW6TDM t FWE D W HI NG
TO 504 E APPEDY I/2 M i LE
DIMENSION OF INSTALLATION OR REMOVAL 1
0 W
11 Zju LB5
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN HAUL DATE : 4 – Z4rq I
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.
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.
i
Signature of Ap�caw',
ent
1fkAVDA n nle5
MOF -0 EM& YIEVONCM -79- SI1 COUIU F9 345-- 1778
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
INN F1 LE OU FM -
Contractor's
l LEContractor's License No. City Business License No.
OM FILE ON FILE
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
10.00
$ 10.00
Date
1079
i00051ejSAOS 1661 4124-91,0.00 10
TOTPERMIT VALIDATION
PERMIT NO. 10-7 q
DATE APPROVED 4-Z4 `° I
EXPIRATION DATE
DATE ISSUED i Z 4 9 1
By
TELEPHONE: (619) 564-2246
Administrative Authority
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NOTE:
%Alitk
this form constitutes an
CITY. OF LA'QUINTA
encroachment permit
rrLIL;AllUN, FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
�OQF TRIP OVEPLeSIIE LOAD PEKMAT)
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 II I
DATE 4-24 1 1' Mino . r Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
MOVE MR.
PURPOSE.OP CONSTRUCTION Sketch (attach construction plans if appropriate)
.DESCRIPTION
IPTION OF CONSTRUCTION. &Z-5 5CEAVEK "AUL 1ROUTE
WA514
-1TOM t FWED WAWIPSG:
7 C) 4. IN q
0 5 F/6: APPEDY 112M I LE
DIMENSION OF INSTALLATION OR REMOVAL 14' h WW
SIZE OF EXCAVATION., IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
HAUL DATE A ZIS -q I
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Iricluding removal of all obstruction, materials, and debris, backfilling,,com-
pactibn 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 ag6nts, 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.
cv)h 11
Signature of Appl cant o gent
r\,VMVDA r2 V N t15
_79 511 COAI_FkY 9013 -tell 3413- 1778
Name of Applicant (please print) Business Address Telephone No.
f. Name of Contractor and JoI5, Foreman Business Address. Telephone No.
OM F1 LE OU HU—
Contractor's License No. City Business License No.
OM FILE FILA
Applicant'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
Inspection Fee $
Permit Fee 10 - 00
Penalty
Cash Deposit -Surety Bond
if.required
10.00
TOTAL: $
Receipt No.
Received by Date
Recorded by
r
1079
ioW
0AY
05 664 i
04-24-91,0.00 10
AL
PERMIT VALIDATION.
c
1
PERMIT No. 10-7
DATE APPROVED
EXPIRATION DATE
DATE ISSUED .1 Zq - 9 1
By
Administrative Authority
-TELEPHONE: (619) 564-2246
40TE:
Nith proper validation
:his form constitutes an
.ncroachment permlt
•
•
CITY OF LA QUINT,A
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
rr I� Subdivision Improvement Permit — Class III ---
DATE: `-I —� - Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION __L02_5 19OLO.4212V—
DIMENSION OF INSTALLATION OR REMOVAL /y — a 0 i 1A )„r
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
0
APPROXIMATE TIME OF COMPLETION bat
Q5
,� 1
ESTIMATED CONSTRUCTION COST,$ �'(L �1
(Including removal of all obstruction, materials, and deb; -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.
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.
A
of Applic#t or Agent
Nuevo Engineering, Inc. 79-811 Country Club,. Bermuda Dunes 619-345-1778
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job ForemanBusiness Address Telephone No.
Contractor's LiSqnse No. City Business License No.
'Applicant's Insurance Company Policy Number
EES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimatedconstruction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Ie
spection Fee
rmit Fee
nalty
ash Deposit -Surety Bond
required
TOTAL:
eceipt No.
eceived by
by
Date
N° X07 q
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564.2246
Administrative Authority