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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 Ill
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION.
' (Street address or Description of Location)
PURPOSE OF CONSTRUCTION OV� VJP.
DESCRIPTION OF CONSTRUCTION 114 I. P
110 , 000-L 85 7N,
Sketch (attach construction plans if appropriate)
HAVL FDUT :
C_IqY . L I M Y T5 0,N W A SN 1 AJ f-�TON
TO TAMP 1 Crb. �.. tIUASf 1 I �KgTa til
DIMENSION OF INSTALLATION OR REMOVAL
- SIZE OF EXCAVATION, IF NEEDED
!-'t AU L UATt :
-APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
.ESTIMATED CONSTRUCTION COST $ PILOT (-AP- _ . EEO VI EE -D
(Including removal of all obstruction, materials, and debris, backfilling,"com-
pactiori and placing permanent resurfacing and/or replacing improvements)
+' In .considerationof 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 Ap li ant • r Agent
TRUCK INN q
PI•CONI �I Gol7-- .al Go
y
Name of Applicant (please print) Business Address Telephone No.
WUE.VD Ck)&INEEZ?h1U 3LIS— J�78
Name of Contractor and Job. Foreman Business Address Telephone No.
DN F1L<E OIV FILA
�y .
Contractor's License No. City Business License No.
O J ' FI LE, ON >F IL E
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
Public.improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1141
Minor Improvement Permit —Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if: required
TOTAL: $ 10100
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. )14-1
cl
DATE APPROVED -7-0-1
EXPIRATION DATE �— Q ' q
DATE ISSUE % 0 9 1
By
Administrative Authority
TELEPHONE: (619) 564-2246
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. �iri'd!.'1a:a• h;f. i _s0 a. ..:.J' i�� "-.... ...� ,.-".. .. ..o ls. ': » .. r.. ....+ a" .. a. Y .-.. !,-Or!.., <c...
H
NOTE:
E
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS ' CONSTRUCTION (ENCROACHMENTI '
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: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or'Description of Location)
PURPOSE OF CONSTRUCTION M OVE Q V)P.. Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION IN's I D LU HAUL Ad UTL
110 000 L95 L Ci'TY L 1 NA 1ft� ON WASH 1 tV C-�'TOA)
TL) -MR P Ili @ U A544 1WTDU 7
DIMENSION OF INSTALLATION OR REMOVAL
i
k SIZE OF EXCAVATION, IF NEEDED
iA AU L DA -M
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ PILOT CAL
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In of the granting of this permit, the applicant hereby agrees to: `
4
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.
k 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.
t •
r J�
Signature of Ap li ant �r Agent
i PION) TRUCKIiNCU 7ILI lel? - 61.111
i Name of Applicant (please print) Business Address Telephone No.
4` NUEVD F_kJ&1A EEE-1A1la 3 15- 177a,
k • Name of Contractor and Job Foreman Business Address Telephone No..
DAf FI LZ OU FILE.
Contractor's License No. City Business License No.
QAJ F I L E., ON F I L E
Applicant's Insurance Company t� Policy.Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3%.of estimated construction costs
Private improvements: 3% of estimated construction costs 14.1
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
Permit Fee 4.h. ` 00 PERMIT NO. I1 U I
Penalty 7-6— q I
Cash Deposit -Surety Bond . DATE APPROVED
if,required EXPIRATION DATE %— G _ C1 I
TOTAL: $ M. 00
Receipt No.
Received by. Date
Recorded by
DATE ISSUED ? r I
By
rr;+akr-s�•e Administrative Authority
TELEPHONE: (619) 564-2246
VOTE: ,.
Nith proper, validation •
,his form constitutes an . CITY -OF- LA QUINTA•
:,ycrokitment permit
`-APPLICATION FOR PERMIT
t PUBLIC WORKS CONSTRUCTION (.ENCROACHMENT)
pP Tf4
For the construction of public or private • curbs, driveways, pavements, sidewalks, parkinq, lots, sewers, water maitis!
and other like public works, improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
II Subdivision Improvement Permit — Class�III
DATEl Minor Improvement Permit Clau IV
.LOCATION OF CONSTRUCTION.
(Street address or Descriptlon of Locadoy/� n�l ,
PURPOSE OF CONSTRUCTION lollye 0-1 ��-,--_ Sketch (attach constructionlplans.if appropriate)
DESCRIPTION OF CONSTRUCTION. 1023
Vn�
DIMENSION OF INSTALLATION OR REMOVAL Ran,
an,
p G 0
V1 0
SIZE OF EXCAVATION, IF'NEEDEO
'APPROXIMATE • TIME WHEN WORK WILL BEGIN y- '
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(including removal of all -obstruction, materials, and deb:•is, backfilling, com-
paction
om paction and placing permanent resurfacing and/or' replacing improvementsl
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, harmfeis from and against any and all
j • penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or properti
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 -tour .124) hours in advance of the time when work. will be .started.
t Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable' rules and regulations 08f the City oi-
La Ouinta and to pay for any additional replacement necessary as the result of this work.
1 1 1 n n.
Signature of A ican r Agent
j p t
.Pi r.nni_ 'i'rltrkinl; 307P3 nlri Car.�l..3�P Rr�_:_1Z��r;.A��7 �p Q��h�' (Z-15ZZzl?Q6.
Name of Applicant (please print) Business Address Telephone No.
Nuevo r' . —13 31
Name of Contractor and Job Foreman Business Address Telephone No.
On F'ile• On File '
Contractor's License No. City Business License No.
On Filp '_ nn F'i1a
Applicant's Insurance Company Policy:Number,
FEES: Subdivision Improvement Permit —Class III
. ..... a.. ....'.. ., ..•....,..... ...v v. wa...wwu a.v. ua. va.arv�. a-vaa
Minor Improvement Permit — Class IV: See attached schedu
nspection Fee $
'ermit Fee
'enalty
:ash Deposit -Surety Bond
requiri:d
TOTAL: $
Iecelpt-No.
leceived by Date
iecorded by
• iii° (lye , - .,
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
.EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619)564-2246• '
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