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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 III
DATE: AUGUST 14, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION nyFRRT7.F. Tmn ARitMTT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION GAT B 9.h
l414114 _146" j;Y,9$ 96 16ONG .23224-2 .„ ftE
DETACH AAD RZOA
Ln IT AW =11111424
DIMENSION OF INSTALLATION OR REMOVAL S
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
VASHIHGTON & TAMPICO WASHINGTON
TO 111 - 111 AUTO CEN. D.
PROVIDE ALL RMUI]I BD SAFETY AND QARNUG
DEVICE INCLUDING SIGH FLAM&
AND FLAGGING
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.
Signature of Applicant or Age
DALTOR TRUCKTPFG 13460 VRTTYRAM Tr wTAwh CA, 1Q2335--714-622-0563
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
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 10.00
Penalty
Cash Deposit -Surety Bond f
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
10Q050�H 118? 81'"' 0.00 i4
.. __ . 1-185
PERMIT VALIDATION
PERMIT NO. 1185 ^
DATE APPROVED 8-13-91
EXPIRATION DATE 8-18-91
D ISS
By
Administrative Authority
TELEPHONE: (619) 564-2246 _ .
r`
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: AUGUST 14, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION nyFRRT7.F. Tmn ARitMTT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION GAT B 9.h
l414114 _146" j;Y,9$ 96 16ONG .23224-2 .„ ftE
DETACH AAD RZOA
Ln IT AW =11111424
DIMENSION OF INSTALLATION OR REMOVAL S
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
VASHIHGTON & TAMPICO WASHINGTON
TO 111 - 111 AUTO CEN. D.
PROVIDE ALL RMUI]I BD SAFETY AND QARNUG
DEVICE INCLUDING SIGH FLAM&
AND FLAGGING
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.
Signature of Applicant or Age
DALTOR TRUCKTPFG 13460 VRTTYRAM Tr wTAwh CA, 1Q2335--714-622-0563
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
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 10.00
Penalty
Cash Deposit -Surety Bond f
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
10Q050�H 118? 81'"' 0.00 i4
.. __ . 1-185
PERMIT VALIDATION
PERMIT NO. 1185 ^
DATE APPROVED 8-13-91
EXPIRATION DATE 8-18-91
D ISS
By
Administrative Authority
TELEPHONE: (619) 564-2246 _ .
NOTE.
With proper validation
this form constitutes an
encroachment permit CITY OF LA QU1NTA
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
DATE:
� / ���J Subdivision Improvement Permit — Class III
�/e
Mina Improvement Permit Class IV
LOCATION OF ;RUION //ev e_q Alle,%s COr
(Street address Description of —Location) �� D 4!!f 7,
><!� �,
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
Co/-04ZA
SIZE OF EXCAVATION, IF NEEDED 2223,22— L.Z4
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION q .4K
ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction, materials, and debris, ba-ltfilling, 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 agerm, officers, representatives and employees, harmless from and against arty and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or propany
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 124) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit a d all applicable rules and regulations of the City of
La Quints and to pay for any additional replacement necessary as the result of this Zra. A
Signature of App li nt or Agent
-60
IW�e 135
Name of Applicant (please priJt Business Address
71fi4Z 3 ,OL63
Telephone No.
Name of Contractor and Job Foreman Business Address
Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company
• Policy Number