1084NOTE -
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
PAE_ TRIP OVUGIZE L0A!D PERMIT
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: 4-2-6-91
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION IM W E E V I P M E M T Sketch (attach construction plans if appropriate).
DESCRIPTION OF CONSTRUCTION 50 OE V\ADNTE?UM A 4 CULL til A TO
1EI5EN1+0WE7K TO bA5H 1AJGTON
�
U1870 c l -TY L)M ITS
DIME�i Z,�Sf!D STA�LSLATION OR REMOVAL14' 7
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:
PR I OfZ Tb MDV AJ&
CALL IZIVCE510E CO. 54EUI1`
FDIZ A55115TAIUCE IS T07ERSEC-T10"
OF. E15EN1F01k)Fe AND WA5NINGTON
(4-) PI L 07 Cry IZ 5 Z5 ,9111 PEED
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 gent
DAL -701V T2UCK 1 NGS 13 5W WHI TTieAM FON TOM CA 7I `I - SZ3 ` 6G63
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
011 FILE.
Contractor's License No. City Business License No.
DN FI L ,E D IV FILE_.
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 $
10,60
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ Id '
Receipt No.
Received by Date
PERMIT NO.
`i8,5,RSHTOTAL4i`b_91.0010i0
011
.. 1084
PERMIT VALIDATION
IOBy
DATE APPROVED LY _ Z&
EXPIRATION DATE q-7-7— 91
DATE ISSUED
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
s. •', •y�..ta:'a:. {�� ,'mow �. a .. '4„ .f v' i. ;.� i +4 � a•;: ,t.,.:rw; ,. r,�.. •; _ .--�-'�~��.. ,
— _ — -- -— — --- .--.,—...._......---. _1--
'C
NOTE•
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION. (ENCROACHMENT)
PA/E TRIP OVEW,,IZE LOAD PERMIT
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 II I
.Minor Improvement Permit Class IV _
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
N D u E E O V I P M E M T appropriate)
.
Sketch (attach construction plans if a
DESCRIPTION OF CONSTRUCTION 50 U, 1MDN'TE1VM A .4 CUL I M A TO
>il`�ENIOWE(Z TOQUASH AJC
DIME I�S'OZN90� JN STA�LLATION OR REMOVAL ..
G b S
PR i N TO 1V10V) fV 67
SIZE OF,.EXCAVATION, IF NEEDED CALL RI VU510E CO. 5HEW) I+
APPROXIMATE TIME WHEN WORK WILL BEGIN F0IZ A5SV2TANE �e O7�RSFGTIUN
OF E15DJHOWU AND Wf951 IVGTDN
APPROXIMATE TIME OF COMPLETION (7—) .R/L.dT C/I(Z5 j 011SCD
ESTIMATED CONSTRUCTION COST $
(Including,removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Inconsideration 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
r
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 ok/Agent
pAL__T T2UCKl�1/C� 13 _&O If11Nl TTKAM FONT14&j CA 7/y- O�3- tl&b3 .
Name'of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
0ti FILE
Contractor's License No. City Busiriess.License No.
ON Fl L E • ;6. j F-1 L E_
Applicant's Insurance -Company Policy Number,
FEES: Subdivision Improvement Permit —Class III ..iK (}S1g g 0 1 4 -gib -91 ' 10
'.' Public improvements: 3% of estimated construction costs i=1U ' CSH i TOTAL 1' 50.00•
Private improvements: 3% of estimated construction costs 10'8 4
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
I :0D
Permit Fee - II l0 y
Penalty
Cash Deposit -Surety Bond
if required
117, dO
TOTAL: $
Receipt No.
Received by Date
Recorded by'
PERMIT 1,40.
DATE APPROVED
EXPIRATION DATE q 27-- '7 1
DATE ISSUED -11 4 Z �' . 9
By
U Administrative Authority
TELEPHONE: (619) 564-2246
MEN
NOTE:
With proper validation
this form constitutes an
CITY OF LA (2UtNTA
encroachment permit
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: �Pri Z,:5-- /7y'/ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION +
;i
(Street address or Description of Location)
, . PURPOSE OF CONSTRUCTION �%✓ems S�Z 'L�� Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION \
DIMENSION OF INSTALLATION OR REMOVAL
�'SIZE OF EXCAVATION, IF NEEDED +
APPROXIMATE TIME WHEN WORK WILL BEGIN lo
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, ba lcfllling, com- 144e--,
paction and placing permanent resurfacing and/or replacing improvements) D
In consideration of the granting of this permit, the applicant hereby agrees to: ` c U,
Indemnify?defend and save the City, its authorized agems, officers, representatives and employees, harmless from and against any and alt
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 1241 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 Cwinta and to pay for any additional replacement necessary as the remit of this work.
r Signature of plicant or Agent
Name of Applicant (please print)"'Business Addreih<:' --•: Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City. Business License No.
Applicant's Insurance Company .. Policy Number