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1106NOTE: With proper validation this form constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 0AIE TRIP OVERSIZE LORD 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: 5`20- 9/ LOCATION OF CONSTRUCTION Subdivision Improvement Permit — Class III Minor Improvement Permit Class IV (Street address or Description of Location) PURPOSE OF CONSTRUCTION MOVE EQUIP Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCT ON SARBER EEN- E HAUL, ROUTE 1211" WIDE 1 ' MILES 4 JEFFERSON To IiVASHINGiDAI 6/0 TO r15E1VH0W,59 To AVE DIMENSION OF INSTALLATION OR REMOVAL FEERNANOO SIZE OF EXCAVATION, IF NEEDED. APPROXIMATE TIME WHEN WORK WILL BEGIN HAUL DATE � "Zd 6,C,5 --V APPROXIMATE TIME OF COMPLETION ONE 014Y iNIL Y H ESTIMATED CONSTRUCTION COST $ (Including'fremoval 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. TIAIA (f -7R.4( -,EY Signature of Applicant or Agent -FA PM AC P D. gOX I yDsa PALM DE'SEET C A 3� 0- 4500' Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. PAI )C7i L E ON FI L E Contractor's License No. City Business License No. PCU FILE Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class II 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: Receipt No. Received by /0.00 $ 10,00 Date 1106 PERMIT VALIDATION PERMIT N0. A I DLA DATE APPROVED S' Z0 — 9 I EXPIRATION DATE S ZI 9I DATE ISSUED By_ 2 Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 r R NOTE: With proper validation this form constitutes an .encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) ONE TRIP OVERSIZE LOAP PERM/ T 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: �r2D r 9 1 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION .(Street addressor Description of Location) PURPOSE OF CONSTRUCTION MOVE EQUIP Sketch (attach construction plans if appropriate) Y DESCRIPTION OF CONSTRUCTION RAREER 6REENIE HAUL, ROUTS 101" WIDE 12' MILES 4 JEFFERISOM To I1VASH1A1677)A1 DIMENSION OF INSTALLATION OR REMOVAL '5/0 TO ,E I SENHOtNE 9 TD A VE FEKAIAN0O SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN HAUL PATE `�20 02 5'Z/ APPROXIMATE TIME OF COMPLETION 01UE 014 G'lVL Y !! 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. 71 AI A C� R,4 GEY Signature of Applicant or Agent -FA IPMAC . U. &Ou 1 �IOSD PALM I) SEPT CA 3&0,45 00 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. _ Z)AI )1 L E D11/ FI L E" Contractor's License No. City Business License No. ,N) F1 L F 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 schedule1.106 Inspection Fee $ Permit Fee /0,00 Penalty Cash Deposit -Surety Bond if. required TOTAL: $ /0-00 Receipt No. Received by Date , Recorded by ' PERMIT VALIDATION PERMIT NO. DATE APPROVED L Z ©- �I I EXPIRATION DATE =21-9/ DATE ISSUED ZO ' CJI By �•,rhva,* f; `Administrative Authority TELEPHONE: (619) 564-2246 P - FR I 1 3 :5? MAS ? MAY ... �,,,, .,� ...,..,....,,, .,,�, .,�„r.,,"�„►�..---,,,m_..�.y........�.�..,�...�..•.... NOTE: w"h prowvolidebort this form eatntr m an CITY OF LA QUINTA encroocnnrtrns oannrt ' APPLICATION FOR PERMIT PUSUC WORKS CONSTRUCTION (EN60ACHMENT) For the conrcructim of public or prwats curbs. driv"ys, pavernmM. sider+aeike, parking iota, srwere, and other tike "it works imprcrvwtwm in conneeaonwndf MINOR IMPROVEMENTS and APPROVEDSyeOIVISIONS Su6divkion improvement Permm - Clao 111 ... � minor Imp v tment P"it Cfat. IV IAr: n()N OF CONSTRUCTION /stn»+ eo�w Or 4ttea�aurt et (.Owtaenl , PURPOSE OF CONSTROMON - - — - -- Sketch eonpnalan pians if a I D RIPTION OF CO 9 faN erg e'S � �J>r tyeS© DtMENS NOF INSTALLATION OR REMOVAL� �A GG � T d 15`°rt YIDuI�' 512E OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WALL, BEGIN APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST S - - �— — —�-~ (,�� "�d� Ilnduding removal of all OhMvuctmn, trtaomals, and drbrts, bsWilline, colt `f✓u� pamon and placing pemfsnent mow faON and/or repiadng ImproirwrwtCal In fonaderstton of th4 granting of 0is cormtt, the applicant hereby ag" to: +� ` InWmnM, astow ens P" me Cllr, to emmem6d opm. ofrwm, rwrowrwtsm" std omieven. ne Imm end "we owa m oilorw+tar, wJ41 " & tat frwivill emm elaarm or covm ae'ven end at*" owt Of env eeotdam. last or e b Oanm+e w .Imml, ftio rtm er Oamm" a t pWrtm w fawn of ow vowk wwwo+ren arts" t" aRmrt ergot" puna" to We "Www on, Nmft mr Aditham" Mrdwhw q Mast tww*w-#, r t241 twY to eovwt w of the " vdoert M�ort1 svYN M vr+.ae. Comotr "%h 411 eoOtetre v!v pm.,w s. tfw trims r�er'fiorittitiorai epP tha'tfa!mtf'tyw'et! tootkaete lu 1Lrw r .., ••.!,,.,•., .•'`' .; .t••.. f,',.•t••„.vW :d:,.r. , (lump anp tie for �r .0MTs-rr f OWW"At ft,� gi"44 Anwq QI. OQF �” vmpro of Apditw% or Agern Name w Acpaasnt ipitssrwv Name or Commor Ano i L Contrsmar's L,ctntt &Ior dus+neu Address T/I•prtane N -5z/Z %Jo Y Suvmm Addrest City Sus+nafu Lianw No, Amil+cent'a Inwrsn4 Corn wy Policy Numuer FEES; Subdivision Immomrson F met -Clan Ili Public improve mi :3% of h'bUmted eommmon aosn Privets tmpro. f Mna: air► of etemated aonstr Mott cn:o tnN O / Minor intoroyterit Psffntt - Cuss IV: Seo attiicned schedule j71 ` Intoact+on Fee S I PERMIT VALIDATION veru/+/ Fto — - _f m 'go Y.O. - --- OATE APPROVED S• 2-0 9 EXPIRATION GATE - -S -Z1 9 / DATE IMEO 5 ' BY r' Admmdm.cpve Aud>orrty PtnM1ty C+sh aeoae:'Surety Bond If teoulred TOTAL: AraYot No, RwMatd by Dna Avow,de0 try