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1137rv. ''+ i• Vfi'Y•(y, '.•� . . �J .f . tiM. ''T P F+�wlk4.�1� 9*'��'�"� • {I NOTE '+ With proper validation this form constitutes an encroachment permit CITY OF VLA QUINTA 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 APPROVEDSUBDIVISIONS �Q Subdivision Improvement Permit — Class,lII . DATE: u ?� Minor Improvement Permit Class, IV LOCATION'OF. CONSTRUCTION 4i .(street addressror Description of'Location) .- t PURPOSE OF CONSTRUCTI,ION ` Sketch (attach construction,plans if appropriate) DESCRIPTION OF CONSTR CTION l _j2jc r � c� ... too Q. DIMENSION OF INSTALLATION OR REMOVAL- , • SIZE OF. EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN;AORK WILL BEGIN �} APPROX-IMATE.TIME OF COMPLETION �. ESTIMATED CONSTRUCTION •COST $ .. Y (Including removal of a'll'obstruction, materials, and debris, backfilling, com paction .and 'placing permanent resurfacing and/or replacing improvements) ' .rin' consideration of the granting of this permit, the applicant hereby agrees to: r 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. Z5 Signature of Applicant or Agent i d J �/Z) Name 'of Applicant (please print) . Business Address Telephone No: Narrye of ContractQLjaFd-JoP Foreman Business Address ZTI phone NO.' Contractor's Licen o. City Business License No.. Applicant's Insurance Company f Policy Number `' t FEES:' Subdivision Improvement Permit.- Class III Public improvements: '34/o of estimated construction costs _ Private improvements: 3% of estimated construction costs .1137 Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $. (( /� PERMIT VALIDATION Permit Fee J L PERMIT NO. 1 PenaltyM —q Cash Deposit -Surety Bond . DATE APPROVED �Jn if; required EXPIRATION DATE / ' TOTAL: $ ATE ISSUED �� I Receipt No. By Received by Date Administrative Authority (619) 564-2246 Recorded by '' TELEPHONE: §. , __ ' � � � i � ._ , ' � 1 4' t t 4. . NOTE: With proper validation this form constitutes an encroachment permit CITY OF LA QUINTA 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: )i Minor Improvement -Permit Class IV LOCATION OF CONSTRUCTION' (Street address or Description of Location) PURPOSE OF CONSTRUCTION .. Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRCTION v / '` �r ��..m L ��cu) - DIMENSION OF'INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED i APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION ESTIMATED, CONSTRUCTION COST $' (Including removal of 6,11 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. Signature of Applicant or Agent.'----) l (:r J1, 'i lL/(' I • �J L ")L1A- / y4I:�l -7 C_it ( `?7� I' llJ:1/1 L Name of Applicant (please print) Business Address T Telephone No 'Name of Cqntractartan,d-JoP Foreman Business Address T lephone No. Contractor's Lice s_ -No. City Business License No. Applicant's Insurance Company. Policy Number FEES: Subdivision Improvement Permit — Class III k, Public improvements: 3% of estimated construction costs 'i Private improvements: 3% of estimated construction costs 113-7 Minor Improvement Permit — Class IV: See attached schedule • 'Inspection Fee $ PERMIT VALIDATION Permit Fee !'=`�—�� PERMIT NO. /•� Penalty Cash Deposit -Surety Bond DATE APPROVED �-` ) j i•f:required EXPIRATION DATE 7-J ' 91 •i l,- ys;�crvYf TOTAL: $ .. „.. g SUE;DSUED Receipt No. r 1 By Received byDate Administrative Authority Recorded by TELEPHONE: (619)564-2246 ^ F' 9 :32 MAS • +••":�� • -0 `. .� r. a... �r r�� Dnp. r� wnI•�+wl+ir �,..� __...�---�Iw. �� o1ir� ` N WeS With Prow validatwrr' this form mrtottttuolta on encroachment Penttrt CITY OF LA OUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTIRUCfION IENCROACHM6NT) For the mnmcum of public or prmato curbs. driwwvavt, peva two, sidomiks, parking Iota, s0' Wen, taaw Mair, and other like public works Imatovontetra in oanno taon with MINOR IMPROVEMENTS and APPROVED SU1jDj1/1SItQW t .. � � � ,� �� . Stibdivition ima>vohtan+ent Pefmlt •'+?��' . Minor Im , Ctafs lit ,�„�,�,� ',hs p•, LOCATION QF COtdST'RUCTiON prorantent PKtnK elm IV ISMaet wanes a Doe of 1•.arn+a�al - ;• , PURPOSE OF CONSTRUCTION Skstch lattatch ammmaion plans if oppeopeleri) :,. d RIPTI ty0 6 _ICONSTRUCTION /� Pule: &I'mita��.5 s I ` , J,p DIMENSION OF INSTALLA t ON OR REMOVAI. SIDE OF EXCAVATION, IF NEEDED APPROXIMATE TIME "EN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION / ESTIMATED CONSTAUCTION COSTS &1e /..+ Ilnciudiag removal of all obstruction, mataneit, and dibHs. badchlN so, Com- paauon and placing pam%ro t term-faicM and/or rtolaeing improver arms In eonuderavo4 of the granting of %tis permlt, the sppliant hereby 69M4 to: Indarnntty, Oefamd aha ewes the 0tv, ret muotonteo accrual. off;mft. feoenm79m" anti woloym. Mn"m ttvm eco 11"m "IF wo W aerott.es. 14ee1t4s of tea rawltiny rwm aawm W noun ea.en W4 mrawte out of atry a tmom. tow a OWWp eo pomp or p"01, mace^wq or Ow++"n a pmzpmti most Of $ft m t H+00mxk*" wmft Ina Parnas pnntud Foment to shit MoW+stilln. NOttfy Vie AOnttnnnmvm Autba m at teed ttvwnnr•Fovr, t241. Nmrs M tte4nm Of the t' m when own toll be 14e!ud. :.:. _ •, • CCMgv Vol" ill sirm" City )civ r!d ill tthtrlet „ , ..:.... • ,,, • , ,� •�' ..... • . _ evoaanrrK, �retnwrir:+tia''4h �ii1�,M�' a� n watt, :.�`n'- . •, •,,, +a�b1+r rues tees +'aw'0+ iNi Geo oi•':c. (�' „p..�r,: -.. .N. 4 .. r.'.iA,. �I •. `• ., r�. .:,. ...4'.:"1.:,.;x:'. t.n „n�:°.w¢'Yl•.. w, .�.nara of Applicant or Agent Fi�r�/11.� Y fir Name of Aopuant 1plrau pnntl 801lnest Addreu fJ Tale No. e'g Name or Contractor an a F amara Sustnea Addntw .. - 42 Can f a t Rdr't L cancra NO, City Bus+neu Licsnta No. APMevnrs Insurance C.Atnaarty -Policy Num aer ...-- FEES; Subdivision Imarc"" ant Pefmrt — Cuss Ni , Public imomwomma: 3% of twbrnatad oonmetton mats Private tmprororiiv"m 3% of etamatea construction mss N� , Mimcr Imprcv~T Ptrrnit - CUn IV: Sw atuMed schedule a lntoeeton Fee 5 PERMIT VALIDATION NMI Fee - Penalty Cash D000tn•Suraty Borw DATE APPROVED H noulraq EXPIRATION DATE TOTAL: 141. DA'L'E I=ED Retstpt Na. — .... 8y Reohvtrd by lbtt — — /idrtu+tatratrw AtrthOttty ; TELEP"Oft (6101 5"46 r J s "NOTE: ..: With proper validation this form constitutes an�: V. !i'• CITY. OF .LA OUINTO z1, encroachment permit ?. ` - APPLICATION FOR PERMIT 4'. PUBLICr WORKS CONSTRUCTION (ENCROACHMENT)'5� • - .. a �, �.. - , �OF •1.1189 . . _ For the construction of public, or • private; curbs, driveways, pavements, sidewalks, lot's;`, sewers,-. water mains 3 _• and other like public works improvements in connection with MINOR' IMPROVEMENTS and APPROVED SUBDIVISIONS ,k Q Subdivision Improvement Permit - Class I I I . ?: DATE: Z,��il -Minor Improvement Permit Class IV ' j LOCATION OF CONSTRUCTION ` 3 li(Street'address or Description of Location) . N iPURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) - DESCRIPTIO OF CON TR CTION Cts`; toll bj,52 DIMENSION OF INSTALLATION OR REMOVAL' W cam' A-- To i t f ,. I SIZE OF EXCAVATION, IF NEEDED fi ,4 - - b APPROXIMATE TIME WHEN WORK WILL BEGIN i APPROXIMATE TIME OF COMPLETION { ESTIMATED CONSTRUCTION COST $ T f (Including removal of al ['obstruction,' materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) !{Y., 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. 0- Notify the AdministrativeSAuthority 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. 22 _ of Applicant or,Agent ! Name of Applicant (please print) Business Address Telephone Nom Naof Contract artd'Jo Foreman Business Address T lephone No. �T Contractor's Lice o. City:Business License No. •. . Applicant's Insurance Company Policy Number , FEES: Subdivision Improvement Permit — Class I II ' - Public improvements: 3% of estimated construction costs i- Private improvements: 3% of estimated construction costs ` 1 1 3 7 Minor Improvement Permit' 'Class IV: See attached schedule' Inspection Fee'' $ n 1� PERMIT VALIDATION I �. Permit Fee /. L 5 7 r PERMIT NO. I Penalty DATE•APPROVED Cash Deposit -Surety Bond '7 Q if required \ EXPIRATION DATE / — F r' I TOTAL: I) 2 _ �ATE ISS E Q z • ( •Receipt No. •^. � ,� � - .• ' Received.by Date Administrative Authority ' Recorded by TELEPHONE: (619) 564-2246 -