1377.L� S
��rTWit E -proper validation
this -form. constitutes an
encroachnr 6f)t 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
y,,. Y.Za �.•• �►� •...}.i'.>.r.. ♦ •..n.-Ia^•:t,.�l-., iJh:--YiN t.�
' Subdivision Improvement Permit — Class III
March 9; 1992 ,
x DATE: Minor Improvement Permit Class IV '
'LOCATION OF CONSTRUCTION
(Street address or Description of Location)
Move equipment appropriate)
PURPOSE OF CONSTRUCTION' Sketch (attach construction plans if a
'.,DESCRIPTION OF CONSTRUCTION Barber, Greene RR 80 Profiler.
ROUTE: From Hwy. 111 - Washingtoti
to Calle Durango to Ave.
�.` DIMENSION OF INSTALLATION OR REMOVAL Carranza.
SIZE OF -EXCAVATION, IF NEEDED ` r
DATE: March 9, 1992
1
APPROXIMATE TIME WHEN WORK WILL BEGIN
_ APPROXIMATE TIME OF COMPLETION'
ESTIMATED CONSTRUCTION COST $ t
(Includin
.removal of all obstruction' materials and debris backfilling, com-
paction
m-
Paction avid plicirig Permanent resurfacing and/or replacing improvements)
�oTCA r-
Inconsiderationthe
IIZ
of the granting of this permit, thea applicant hereby a rees to:
, 9 9 P PP Y 9
Indemnify,^defend and save theCity, 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
ha enin" or' cc rin
,- - pp g o ur g 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
If La Qiiinta and to pay for any additional replacement necessary as the result of this work. •'µ
- . Signature of Applicant or Agent
't
S andono
C.•Inc
P.O. Box 903 Coleen CA •
714 8 7-2
c
7 126
Name of Applicant (please print) ' Business Address Telephone No.
Name of Contractor and Job'Foreman Business Address Telephone No.
On file
!Coi tractor's -License No. City Business License No.
On file r '
Applicant's Insurance Company . :. Policy Number
—V7 74
0 i
' FEES: Subdivision Improvement Permit`- Class I I I 1CASH0Z IV 0AL i 10'.00
1
Pub lic'improvements: 3% of estimated construction costs 'r •� ^�
Private improvements: 3% of estimated construction costs !, 3T i
Minor Improvement Permit — Class IV: See attached schedule
'"Inspection Fee . `$
S�
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
$ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. -1377 r
DATE APPROVED 13/9/92
EXPIRATION DATE
DATE ISSUED 3/9/92
By1 n�GtT•�
0 Administrative Authority
TELEPHONE: (619) 564-2246
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
9 g� Subdivision Improvement Permit — Class I I I
DATE: / 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 CONSTRUCTION
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 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.
Signat re of Applicant or Agen " 17/l�
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 1350
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $'
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE:. (619) 564-2246
Administrative Authority