1180NOTE:
With proper validation `
this form constitutes an CITY OF LA' QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC"'WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private -curbs, driveways, pavements, sidewalks, parking lots, sewers, water • mainsr
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
' Subdivision Improvement Permit — Class III
�
4. DATE: 8"'12"91 Minor Improvement Permit Class IV.
LOCATION OF CONSTRUCTION RIERSIZE 7.0d)
(Street address or Description of Location)
c PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
r'
DESCRIPTION OF CONSTRUCTION SAT 925 RArXHQE 3 AXLR UAtJi, ROUTE: 50TH AND JEFFERSON WEST
'TRACTOR 2 AXLF.ETRA7T.FR 1 7 a inn TAS TYGAT.
j M 10!W LEGAL T,ENCTH T,QVRRRANG TO 50TH & 8)�BESHOWER
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)
In consideration, of the granting of this permit, 'the applicant hereby agrees to:
Indemnify, defend and save theeCity, 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 w en work will be started. v
Comply with all applicable City Ordinances, the terms and conditions of the permit ad al pllicable rules and regulations of the City of j
La Quinta and to pay for any additional replacement necessary as the result of t o `
ure oKXpplicant or Agent
GL GAYLOR CONSTRUCTION CO P.. BOX 403 THERMAL CA 399-5308'
Name of Applicant (please print) Business.Address Telephone'No.'
LARRY GAYLOR
Name of Contractor and Job,Foreman Business Address Telephone No.
PAN AMERICAN UNDERWRITERS ,
ontractor's License No. .City Business License No.
" 524011
Applicant's Insurance Company Policy Number.
at AQ_41_i0.
i0 CASH .i TOTAL i
FEES: Subdivision Improvement Permit —Class Ill t "
,
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1 1 8 0
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10-00 PERMIT NO. 1180
Penalty
Cash Deposit -Surety Bond DATE APPROVED R-1 2-91
if required EXPIRAZ N DATE 8-12-91 , —
TOTAL: $ In -nn
DA EIS 1pl!;�7 L8-12-91
l
Receipt No. By'
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
id
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
aI -i Subdivision .Improvement Permit — Class III
DATE: Minor -.Improvement -Permit - Class AV- --- -
LOCATION OF CONSTRUCTION�bw� o�_� �i» ^
T' a S o d= LC11 I Se ,,j o w .2r�
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 3 A KLA -t'�p� C�rOly i
SIZE OF EXCAVATION, IF NEEDED I a S o O LC:� S
APPROXIMATE TIME WHEN WORK WILL BEGIN Lev L h��
APPROXIMATE TIME OF COMPLETION J O a `w _ I
ESTIMATED CONSTRUCTION COST $ L� A L t' Gtv '}'�� % C7u zs;U�,AVJ
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) 444AL4v L .
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.
k• L . !& iA Q L O rl.,
Name of Applicant (please print)
L'Ly iA
Name of Contractor Job Foreman
S��lo�1
Contractor's License No
Signature of Applicant or Agent
C> . J4 0 3 . i�eti�h�i . X19 - 3li9
Business Address Telephone No.
Business Address
Telephone No.
�-Iry )ouslness License No.
� �'Le��t,l �i ►� Gf �cle.��'u2� �' e(� � �) '�ho►,� -C,
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 b
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO
DATE APPROVED X !a
EXPIRATION DATE 06`s $ FIZ 9.
DATE ISSUED g 1 ) - `� 1
By
Administrative Authority
TELEPHONE: (619) 6642246