1109NOTE:
With proper.validation
this form constitutes an
encroachment permit
99
L 4 ,
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS. CONSTRUCTION (ENCROACHMENT)
DNF_ TRIP OVEP,SIZF LOAD 1-2F—R,114IT
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. 2 0 — 91 Minor Improvement Permit Class IV
.LOCATION OF CONSTRUCTION
(Street address or Description of Location) _
PURPOSE.OF CONSTRUCTION M 6 VE EW I P Sketch (attach constructionlans if appropriate.).
ppropriate,).
DESCRIPTION OF CONSTRUCTION /8 TON CZANE A L_VARADO k M ON7 0ZE Y To
9' w iy'k �� ,t f E5t � M U D A 5 TO S�, E/8 To
W/4 5R IA16 TO Al N//3 7
DIMENSION OF INSTALLATION OR REMOVAL CITY LIM I T5
SIZE OF, EXCAVATION, IF NEEDED -
APPROXIMATE TIME WHEN.WORK WILL BEGIN 14.A111- DATE S" -ZD- q /
.. 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.
TIA A C7EACE.Y
Signature of Applicant or Agent
TA9A4AC '7.D: goX.!y050I'ALILI DF CRT CA 300- yS00
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address 'Telephone No.
ON FILE ON F/LE
Contractor's License No. City Business. License No.
ON Fl L
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit.— Class III
Public improvements:,3% of estimated construction.,costs.. • M 1109
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
TOTAL:
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. i10 q
DATE APPROVED 5'20 9
EXPIRATION DATE S'ZD — SII .
DATE ISSUE_ D.
By �� �/►^
dministrative Authority
TELEPHONE: (619).564-2246
' 17' .. . ^.,�,y
1 1 .. _ .... Ja` � 1 i r' � �
. ! � ' J
. , � � � '�
l
\` Y .. ..
L �
_ �, � �� r
� 1� � ,y��
.
11
_
`
�,
,�
� 1� � ,y��
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
PNE TRIP OV-R51ZE LOAD 1-21_--,eM JT
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` 2 0 9 1
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION AAbVE
El?V I P
DESCRIPTION OF CONSTRUCTION /6 TON QZAA11e'
DIMENSION OF INSTALLATION OR REMOVAL
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)
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
A L VA/ZADO k M DIV7r_'k V TO
E)E j M U D A 5 TO 52 Elb TO
WA 5N /A/C, 70 Al N//3 7'0
CITY LIMIT 5
NAl/L D476 5'-2D-91
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.
TINA 6F_ACE Y
Signature of Applicant or Agent
TARMAC O.D.8OX 1'I05-0 PALMI DESFRT CA 3100- ilsoo
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE ON FILE
Contractor's License No. City Business License No.
ON 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 $
Permit Fee 10' 00
Penalty
Cash Deposit -Surety Bond
if, required
TOTAL:
Receipt No.
Received by
Recorded by
$ Jo -Po . 1.4 +•
Date
PERMIT NO
1109
PERMIT VALIDATION
//Dy
DATE APPROVED 5-20-9/
EXPIRATION DATE SZ0 " G/I
DATE ISSUED j�
By )Y�Administrative Authority Authority
TELEPHONE: (619) 564-2246
P � �
r/M
— 9 1 F R I 1 3 M A 5
M A Y — 1 .� ...,. ..... . +s r�-r�
i�fr
r M^ o.., r� .wr �v �� �i Wr.�.r��—n
.—. .� ..+....�-.
;., ly''•1 .
NOTE:
Ipfdi prom wu"n
this farm carmmttrtrs an CITY OF LA QUINTA►
lnCrvacttntenr Oenr+rc
APPLICATION FOR PERMIT
PUBLIC WORMS CONMUCTION (ENCROAC11IMENT)
For tns col%mman of punk or prwlta curbs, driv"v0s. pavmvr►sa; sidewalks, parking iota, wmn, water
and other Ilkie puoiic works imprpwntrrm in cormecnan with MINOR'IMPROVEMENTS and APPROVED SUBDIVIS104
r 5ubdivislon improvement Fermat .• Ctaas IN
:� d � ':
. , �,,.
DINE::.,iL / Minor Irnptovinaent Prrfnrt t�atr IV .,.,,
; }; `
LOCATION OF CONSTAUCTION
IS~ ado" or Oedo+eroon M Ldbceraonl
"
PURPOSE OF CONSTRUCTION Skit h iStnth attltUM01on owns if
0MAIPTIObI OF CONSTR ON
Ain U-,'44 5 '/0
DIMENSION OF INSTALLATION OR REMOVAL Tcl a
- - - — 0 4a
SIZE OF EXCAVATION. IF NEEDED
my
APPROXIMATE TIME WEN WORK "LLL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS r
(tnduding ramovsl of sit obatructaon, terror its, and debris, backfilling, oaar /// /"'� +' •{; ;
paeaon aa0 vlsring pormartent rtnarfawq and/or roptaci q iMVfAvr ftM1
In considersoon of the V utiq of this Dernlit, the apolicant heretfy agrees to:
indemnity, dbtend ewo ohs Vub Chr, M Sud omod agnea. b"kwft, NVMWrft" a and erooteveve, N ffl"M hvm ane 610w t uvy enr
(1eMim. liswinieb or toes rauin•ro horn aerdsv tar court ao:wn end Pill" *A of WN SM40m, ba w cum" 1d weir♦ ar wispow =•�"" •;'
1+.00M+ine or tf«wnnr ea a arax«tr.a Nwit of" vowk anerrmrwrn vr4w Me oa*+*1 Irm"110.0unuent too* wplrLlarit.
. Notify the A&nowrerra AwQwwTW amen hvvv v-fvur tial awn vi edve.ce Ot fTe twrr Mht90 No+R er•II the etened. .,1; •'N „iY4. 1,T...,'. '"+',.�'�". �'r.,.,.,
.. WWF#b/1♦',.l'SVgAMtarea+.ttM,iMt'�Mr.S%;?,�
' Carni a.m Ni �Frie"tqt-h.�•ratv�0,
fr.:`•.!,`4t-'•, ...::y.•._.d,
::!' ^;tial ,e. ",i:', .r{:� �'u (3uinEi` na t4 Ob 1 e 'Odtin'OgMf..ri'WOopTeitYt tpl 9 he6!!b• "h `'` -• .• .,, ., :'•:: ..
.vt^C•1�`'' ,•t • . ,;J?;" . "i• til': .'C's'•, �r ,. ��..
.:'i'.., . , ., , .. .., � ;kr'^.. "k;i ,'�:'.H;: ?�jr'�•rc:�'�,��?T•"9�,.,' . • "�'h'•' '"J .',"' ' .
SirAwMot Appit"t or Agent
Name or Amrcant (crease
Name ar Contractor ano
Contractor's L,unw No. A
,
business Address
Businew Address
Tilew ons No.
City Busanrts License No.
Avol,ant's Inturanoe Coirwanv Policy Nutnoar
PEES: Subdivision Imat9.enarrt Petrnrt •• Clea III
Public irriprovemrnp: 3% of asterund CoMtrV01on COM
Private }mtxowrrt nu: 3% of dwrnated eonaru-min case 140 J/0
Qr
Minor Imorovtn*ns Prrmrt — Class IV: See stuched scheduss ii I
insobotion Fes 5- - -- -- --- __ —.--
Ptrmit Fre - - - — — —
.
Cart: ototisit•SuraY sand
If reauiteo
TOTAL: i
—
Reorrved by Iita - -
Reow,aw by
PERMIT VALIDATION
�5RMIT NO.
0A
DATE APPROVED - -- -
EXPIRATION DATE—
DAT E L'r'Sr1ED - - —
I3Y Admmat?etn+ Aarthortty . '
Tyyf rro.w•.r -