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1107.;� • <'id .�,s - '� 4'.{�-�l, t �' 2' 4T A..r.t•�±"- 4•g. ffr'`1""f?9-'r� a k: �..�➢'T,�,.'1�r _ j .yam -s -m. r.M I'1! '.F.. �C S � <� . � ,apt., .,,kyr..:. � 7.: •_. i+u.4� � -,[�r - NOTE:' With proper validation this form constitutes an CITY OF LA'"QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS -CONSTRUCTION (ENCROACHMENT) OVEQ51ZE LOAD .PER'M/T For the construction of public o0tprivate curbs, driveways, :pav ,ments, sidewalks, parking lots, sewers, water mains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS DATE.- LOCATION ATELOCATION OF CONSTRUCTION Subdivision Improvement Permit — Class III• Minor Improvement Permit Class IV (Street address or•Description of Location) PURPOSE OF CONSTRUCTION �UF �QV 1 P Sketch (attach construction plans if appropriate x DESCRIPTION.OF.CONSTRUCTION D 8K DOZER 14,40L FowTE So + l.U/ /3 To 6-).45; f yDIMEN510N OF INSTALLATION OR REMOVAL.LEGAL N/ 70 GIT I/. LlM l %S w 120. coo C5 PAU L DATE, -5-1i�-G'1. SIZE -OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 1 PIL07 CAE EEQvl2E-D 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 a ents officers representatives and employees, harmless from anda against any and'all pehalties, liabilities or loss resulting from claims or court action and arising out of any accident, tfo1 o ,oda ge t� pars s gprgPerty .?, 1 happening or occurring as a proximate result of any work undertaken under the permit granted p t'S .4z r i ��`- n 1 7711 ( 1 1 x.0.:00 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 lica 9 or Agent 9 P .NOF VO E_hIG 1 NEE91A16 s- /776 Name of Applicant (please print) Business Address Telephone No. 121 -e 7aac&,, J6 _39723 otl> eD, /' me. j2�E7;f t71'-0'7:�- g/9Cp Name of Contractor and Job Foreman Business Address Telephone No. 0/1/ F1 L E Contractor's License No. City. Business License No. DN I EON. • ,rIiLE Applicant's Insurance Company. Policy Number FEES:. Subdivision Improvement Permit —Class Ill 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 . /0,00. Penalty' 'Cash Deposit -Surety Bond . ifrrequired TOTAL: $ y Receipt No. Received by Date Recorded by 1107 r PERMIT VALIDATION PERMIT N.O. �/ 7 DATE APPROVED EXPIRATION DATE 5 . �� — 9 DATE ISSUED `�. 6 9 S / Administrative Authority TELEPHONE: (619) 564-2246 - --- 1 NOTE: With proper validation this form constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) OVEE51zE- LOAD RECM IT For the construction of public or'( private curbs, driveways, pavefnents, sidewalks, parking lots, sewers, water mains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS DATE 15- /S— G%/ LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION MOVE E00P DESCRIPTION OF CONSTRUCTION D Sk DOZ .DIMENSION OF INSTALLATION OR REMOVAL LE&AL H Z 0, 000 L 135 Subdivision Improvement Permit — Class III Minor Improvement Permit Class IV Sketch (attach construction plans if appropriate) PAUL Zou,TE So -n U)/ 5 7v UJ45,4 AJJ8 7o e/T(/ LIA417S M A U L DATE_ 5- -ho -G SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN ) PI L 07 Che E ECS 01X e_D 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,/�ltolss or damjgeto per nns i pryperty 1, happening or occurring as a proximate result of any work undertaken under the permit granted Ap�Ir3air�Q,a#Vis1`ad��at�Lf�.� l2o•oo Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work willbestarted. H 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. r Signature of Applicafyt or Agent �^ N UE VO EIUG I AI EERIA16 315-- /776 Name of Applicant (please print) Business Address Telephone No. filleOAII 72eac&,,"/Ci -3 72j OL0 r/',►ED. 14Wrzir7W 0"0&77-yq(p Name of Contractor and Job Foreman Business Address Telephone No. 661 FI LE 01v Fi L C Contractor's License No. City Business License No. 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 Penalty Cash Deposit -Surety Bond if,required TOTAL: Receipt No. $ io, 00 Received by Date Recorded by 1107 PERMIT VALIDATION PERMIT NO. DATE APPROVED S IIS -91 EXPIRATION DATE 5 �� DATE ISSUED By Z. Administrative Authority TELEPHONE: (619) 564-2246 ` th proper validation • • is form constitutes an CITY OF LA QUINTA croachm' ent 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 1 Subdivision Improvement. Permit — Class 111 TATE: `� f Minor Improvement Permit Class IV ,OCATION OF CONSTRUCTION ;treat address or Description of Location$ p URPOSE OF CONSTRUCTION . rn-- Sketch (attach construction plans if appropriate) )ESCRIPTION OF CONSTRUCTION OF INSTALLATION R REMOVAL )IMENSIONi� e moo_ VNIC ;12E 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, backfilling, coma paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of. this permit, the applicant hereby agrees to: oild Indemnify, defend -and save the City, its authorlied 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 1241 hours in advance of the time when work will be started. Comply with all applicable City I 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 additlonet replacement necessary as the result of this work. (- -I r•rII-K Ir1r, . .3"I -• •t -II(I V.Hr•r•Ig6(- rirI . 9 lrlllr•r•,.F�r-;j I uiA n - 1� f lji.,L n j - n=yj ame of Applicant. (please print) Business Address Telephone No. —.345—j_y 78 ame of Contractor and Job Foreman Business Address Telephone No. On File On File ontractor's License No. '' City Business License No. 's Insurance Company jEES: Subdivision Improvement Permit — Class Ill Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Fee $ mit Fee Deposii-Surety Bond ulred TOTAL: $ No. ed by • IDate by Policy Number N° / lo'7 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE: (819) 5134.2246 I