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1471-+' NOTE: With propeir validation this form constitutes an CITY OF LA QUINTA encroachment permit -, ,vAPPLICATION• 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 111 DATE: June 22, 1992 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 53-490 Avenida Montezuma (Street address or Description of Location) PURPOSE OF CONSTRUCTION --=Addition Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Install new waterline DIMENSION OF INSTALLATION OR REMOVAL Approx. 100 ft. .See attached sketch as provided by owner SIZE OF EXCAVATION, IF NEEDED 12' x 18' deep trench APPROXIMATE TIME WHEN..WORK WILL BEGIN 6/22/92 APPROXIMATE TIME OF COMPLETION 7/6/92 ESTIMATED CONSTRUCTION COST $ 50.00 (Including removal of all obstruction, materials; and debris, backfilling, com- Upon completion of construction, area shall be graded and restored to original condition. r' 105'82ASH VMTA� r`r92 25:00 14 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. f Signature of Applicant or Agent Ronald E. Phelps 53-490 Montezuma La Ouinta CA 92253 564-7303 Name of Applicant (please print) Business Address Telephone No. Owner/Contractor Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License,No. City Business License No. State Farm Insurance 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 Inspection Fee Permit Fee Penalty I Cash Deposit -Surety Bond if required TOTAL: 25.00 $ 25.00 Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. 1471 DATE APPROVED 6/22/92 EXPIRATION DATE 7/6/92 DATE IS UED - 92 By D Administrative Authority TELEPHONE: (619) 564-2246 0 ,n --------- ------.----- --- 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 e— �u� 22 NO 1` I- I� Subdivision Improvement Permit — Class III DgTE: I` � Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION � Iq tO I "-1ONTe7_Q &. (Street address or Description of Location) PURPOSE OF CONSTRUCTION ���� 1 Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION NF�U ',WLO 1Nff DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL,BEGIN APPROXIMATE TIME OF COMPLETION �� ESTIMATED CONSTRUCTION COST $ o • lop (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) V J NEIN "VAl Ea �_ ✓ � L_I SIC YhG�N7EZ1t4 EXtSr wo•'tEI�M�El2 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 res t of this work. ignature of Applicant or Acfent me of Applicant (please print) Address Telephone No. =rn�L Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. Applicant's Insurance 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 Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. _2 Sc -30 $2 rs ca Received by Date _ Recorded by City Business License No. Policy Number 1236 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE:. (619) 5642246 ..