1197I®
.14
"J"
^- •NOTE: f
—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
.t
and other like public works. improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
F Subdivision Improvement Permit — Class I II
DATE: 8-26-91 Minor Improvement Permit Class IV
s. LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION RARARR CRFRNF. RAVER 1 1 16
W nF %RR mT Er.Air Lgu6T vgTrXT ROUTE 52 &JEFFERSON TO BERMUDAS
TO NOGALES & TO MONTEZUMA
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION; IF NEEDED
•1.�` A
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 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
t. ✓
TARMAC. rAT:TFnRNTA Tmr. ' P,n_'ROX 11405.0 RAIN VIR$EIT CA 92255
Name of Applicant (please print)` Business Address Telephone No.
Name of Contractor and'Job Foreman Business Address Telephone No.
,
ON FTT.F ON FTT"F.
Contractor's License No. City Business License No.
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 r<`
Inspection Fee $ II PERMIT VALIDATION
Permit Fee 1 n _ On
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT NO. 1197
DATE APPROVED 8-26-91
EXPIRATION DAT A-92-91
DATE S 8-26-91
By
Administrative Authority
TELEPHONE: (619) 564-2246
0
1r
AUG -26—S+ 1 MON 1 4 '49 MAS P O 1
NOTE:
Whr, pmour vend
this form mrtmurm an
tnaroeer<mtnr Oernlrt CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CON.MUCTION (ENC'
i;OACr(PRENT)
For the tonatrtcum of Putaie or prlvtte curtrs, driveways, pays ten sidewetke, perking lay, sewn.
Ind Omar like pudic work, imarovwrwR= in connection with MINOR IMPROVEMENTS and APPROVED SU9pIVISIO q
DATE: % j Suwivivion Imommunt Porm t — Cteq I
PAlnor Improrwrwrtt P..,,Ctas IV
LOCATION OF CONSTRUCTION
juices mot or 13�pyo, a i�onl i
PURPOSE OF CONSTRUCTION ,
Sketch (much cor"u jM oa Won$ if �
D RIFFTION OF CONST ON011A
^ rr• n0 t�(� � ��
DIMENSI OF INSTALL.AT(ONOR REMov ��% �'/'% L �I.;)
d /.° 4o
;IZE OF EXCAVATION. Jr. NEEDED
APPROXIMATE TIME /AMEN WORK wiLL6EGIN
;PPROkIMA'TE TIME OF COMPLMON
ESTIMATED CONMUCTION dOST S
(In dudi
n4 mm�vitl of all oOtdewzJon, trwtahais, and dabro,'.+acicfilli .
pacbon Ind placing Por"unent rt4eurts np, cors}
t�req and/ti, npladnp ImprOtramettgl : s. ,t. •
In conetderatJon of the P+nttnq Of thts Omni%, the eppiipant heneny agrrtt'a W;
ifplMln,ty, 0►ter a krC am the errv, IN bumm eed eland, a►rKara• me 00"I two &W
owM,ber. IAbunwe of son rtfryft,
h nl
from p+win 0► fAYft ,awn Uld 8rwfrt� OUY ar tier/ iKrwem (ems tion OA7 a� pM ell au
Ow om—V 19 a Omxwtum town of any woo 4,mvemaks" wrow elle Dom" dented Ottfr�enf ��eto �OUeli, � �� ••
Nottty me A&",ngt,ed„q Aver"'" et kle,n R,gwrvewr t241 hown m etrverlry � } , ^^• '
Lj ricomo nd `nett A -mow City Ordsl{vg4. tAe tertrra t/d t�orad,4pfa f!I � � sena votlrrl vmft MH be xw=d,
to Dov #W RY eCORUOraI reOfBOeTfn7 mW=eWv at Inc mmot or ePut,Crtde 144fa awm feMateanr to Irlt Ci
5+tfr►etut! of Apptotent r Agent ?' '
Name of Aaouegnt toteaae trJnq ,, •;'�•',
Bus,ness Addrass t:;R
Title
Nerve ar Contremend Jo0 Portman 5�
Cenaaeior's L.can , No, Ttlt No. Y1 '
C.,ty Bust
ntsa License No.
&.01scunin Insurance
Policy Humor
FEES: Submmion lmw,,,gnt Parm•t
Ctaa III
Public Improvtrnwitit: 3!6 of trorr►etad r0
Private im nttrMjan Cora
t7v+M®rrq; 3% Of knMu too oanatrumon cc.
MinOr Itr0fovemwnt Permit CVd IV: Set ermts,ed Icn►dule No.
inaeeerton Fee S
I PERMIT VALIDATION
dermis fee - '
Pen,try , °.9MIT r;0.
Cmh D"M11-50etV ®ond
If etovtred DATE APPROVED
TOTAL: EXPIRATION DAIT
Aeonot No. DATE ISKIJIED ;
R"*NW by 6y
Reanrood try Adnwn4v ntre Misr"
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