1554With proper validation+
:this form constitutes, an
encroachment permit
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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
w ,
»�. Subdivision Improvement Permit — Class III
DATE:_ 8$kP 0T4h^r '23, '1902 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-980 U•1ej0 1'a QU$Ata!
' T (Street address or Description of Location)
PURPOSE OF CONSTRUCTION Dr3.'rtattit Y 492r"Ch Sketch (attach construction plans if appropriate)
a DESCRIPTION OF,CONSTRUCTION POR MMIDE COMM S'V• NO., 207,
DIMENSION OF INSTALLATION OR,REMOVAL '
SIZE OF EXCAVATION, IF, NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 9/24/92 t.
APPROXIMATE TIME OF COMPLETION 10 1 92
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.
t 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 result of this work. • �'
Sign{ Ure of Applicant or Agent
• Jams fl.. sAttley 41625 ft#ectric P&lm Dosso t„ Chi �, .. 340-1361
Name of Applicant (please print) Busine'A Address Telephone No.
Name of -C6 ntractor and Job Foreman Business Address Telephone No.
248823 856
Contractor's License No. City Business License No.
Travalaxai Insurance Co, 0001$274
Applicant's Insurance Company Policy Number
FEES: Subdivision'l mprovement Permit — Class I I I
Public improvements: 3% of estimated construction costs T F f ��� 9-t3M�� 3o, 1�
Private improvements: 36/.'of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20,00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
t W44 -
PERMIT VALIDATION
PERMIT NO. 1554
DATE APPROVED 9/23/92
EXPIRATION DATE 10/1/92 1
DATE ISS ED 9J23/92
By
'Administrative Authority
TELEPHONE: (619) 564-2246
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
w ,
»�. Subdivision Improvement Permit — Class III
DATE:_ 8$kP 0T4h^r '23, '1902 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-980 U•1ej0 1'a QU$Ata!
' T (Street address or Description of Location)
PURPOSE OF CONSTRUCTION Dr3.'rtattit Y 492r"Ch Sketch (attach construction plans if appropriate)
a DESCRIPTION OF,CONSTRUCTION POR MMIDE COMM S'V• NO., 207,
DIMENSION OF INSTALLATION OR,REMOVAL '
SIZE OF EXCAVATION, IF, NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 9/24/92 t.
APPROXIMATE TIME OF COMPLETION 10 1 92
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.
t 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 result of this work. • �'
Sign{ Ure of Applicant or Agent
• Jams fl.. sAttley 41625 ft#ectric P&lm Dosso t„ Chi �, .. 340-1361
Name of Applicant (please print) Busine'A Address Telephone No.
Name of -C6 ntractor and Job Foreman Business Address Telephone No.
248823 856
Contractor's License No. City Business License No.
Travalaxai Insurance Co, 0001$274
Applicant's Insurance Company Policy Number
FEES: Subdivision'l mprovement Permit — Class I I I
Public improvements: 3% of estimated construction costs T F f ��� 9-t3M�� 3o, 1�
Private improvements: 36/.'of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20,00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
t W44 -
PERMIT VALIDATION
PERMIT NO. 1554
DATE APPROVED 9/23/92
EXPIRATION DATE 10/1/92 1
DATE ISS ED 9J23/92
By
'Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an
encroachment permit CITY OF LA QUINTA ,
I
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: / ` �--� _ / Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV•
LOCATION OF CONSTRUCTION
(Street address or Description of Lo ion)
PURPOSE OF CONSTRUCTION Mwy_ was✓ 0OL-AcN 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. n //
J A Yhg.5 0- J•9 7`t
Name of Applicant (please print)
Sign t re of"Applicah or
CC_1 rc. " P41w-► A
Business Address
"CIOI LI
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
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Recorded by I " TELEPHONE: (619) 564-2246
Administrative Authority