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1553NOTE: , —With proper validation -tKis form constitutes an' encroachment permit CITY OF LA QUINTA T 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 - r Subdivision Improvement Permit — Class III DATE: 8*0umber .2z. 1992 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 52;-770 Ayoulda Dii►s 4 (Street address or Description of Location) , [' PURPOSE OF CONSTRUCTION ft1*1le�a'�r Approallah > Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION -Por Uvoreide County Std. .41207 (Attached) " DIMENSION OF INSTALLATION OR REMOVAL 6" * 201 . - r SIZE OF EXCAVATION, IF NEEDED `•Una' I a2 --221-92 APPROXIMATE TIME WHEN WORK WILL BEGIN 9/24/92p�sg 30" 14 . ,APPROXIMATE TIME'OF COMPLETION 10/1/92 '_ESTIMATED CONSTRUCTION COST $ ` 300.00 a . (Including removal of all obstruction, materials, 11 debris, backfilling, -com- pact . ion ackfilling,-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•auttiorized 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) • hoursdvance of the time when work will be started. ' Comply with'all .applicable City Ordinances, the terms and conditions�o the p mit and all applicable rules and regulations of`t a City of La. Quinta and to pay for any additional replacement. necessary as th resd t of i170 k. Signature of` pplicant or Agent" David Roo& xWer 1'.0. Baa 722 La Quiata, CA 92233 564-5823 Name of Applicant (please print). . Business Address Telephone No. ,.d Pacific Ty des 8a>aus Ba�nQ Name of Contractor and Job Foreman Business Address Telephone No. ' -142538t 19 5 Contractor's License No. - City Business License No. Varoaaze insurance F909$6 43 88 Applicant's Insurance Company Policy. Number r i FEES: Subdivision Improvement Permit'— Class III 4 Public improvements: 3% of estimated construction costs a Private improvements: 3% of estimated construction costs `• Minor Improvement Permit — Class IV- See attached schedule f . _ 't Inspection Fee $�O.Q© PERMIT VALIDATION .. Permit Fee 10.00 _ PERMIT N0. X553 Penalty Cash Deposit -Surety Bond if required , TOTAL: $ 30.00 Receipt No. Received by Date Recorded by DATE APPROVED 9/22/92. EXPIRATION DATE 10/1/92 DATE ISSUED 9/22/2 r By 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) -----Vim'-------- 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 ;Z— Subdivision Improvement Permit — Class I I I DQTE: �'� C) Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Z - i 1 A`� C. fl) ` A--2-- (Street address or Description of Location) PURPOSE OF CONSTRUCTION — 111 01 '-OPEl rA ft_c-)A- A, DESCRIPTION OF CONSTRUCTION S Q DIMENSION OF INSTALLATION OR REMOVAL to 14 SIZE OF EXCAVATION, IF NEEDED S APPROXIMATE TIME WHEN WORK WILL BEGIN Z Sketch (attach construction plans if appropriate) APPROXIMATE TIME OF COMPLETION ( `.� K ESTIMATED CONSTRUCTION COST $ Zy 0 .--- (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 their ult of th s rk. F� U Signature of A plicant or Agent -1z 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 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 12.3 6 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By TELEPHONE: (619) 564-2246 Administrative Authority