1591�r�hyw
-NOTE: '
With,proper validation
this form constitutes an
b encroachment permit
N 'z._`
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
(00iC 'Trztp oveZ51Zc LOA PEe't-+t7')
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 I
DATE: 11-3-92 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
' PURPOSE OF CONSTRUCTION Momfo equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIM 0§ION OF INSTALLATION QR REMQVAL Transformer
1�0 long, Heist] iagal. 9'6 tride
.Pred Waring to Wasbington to 52nd
to Monroe to 38th
Ueetinat&on 81-600 58th St.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 11-"2
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. ,
,S%6 nature of A "cant or Agent • v
COmbined TBanrsport, Central -Point 085. 9730! - (800) 547-2870
Name of Applicant (please print) Business Address Telepl o3ne,No.
Name of Contractor and Job Foreman Business Address Telephone No.
On iilie
Contractor's License No. City Business License No:
On f ile
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs to
14.00 i0
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule 1591.
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
10.00
$
Date
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
1591
11-3-92
EXPIRATION DATE 11-3-92
11-3-92
DATE ISSUED
/Administrative Authority
TELEPHONE: (619) 564-2246
(i
fie.
y k=
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
-,PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
-tfup oveQatZ� [.cva��-��
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
91 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 1Utl2V- 150"Tt EOT
DESCRIPTION OF CONSTRUCTION
DIMENSIAN OF INSTALLATI
SIZE OF EXCAVATION, IF NEEDED
REMOVAL
APPROXIMATE TIME WHEN WORK WILL BEGIN ((- 7- -! 2
Sketch (attach construction plans if appropriate)
OA'W A�U
. r►'l Rom
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,.+Rsult of this work_
�0 7�
Name of Applicant (please print)
Name of Contractor and Job Foreman
Contractor's License No. `
i lure of Applicant or Agent
��
L - g
Hess Addrets Telephone No.
Business Address
Telephone No.
City Business License No.
Applicant's Insurance Company Policy'Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimatedconstruction 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�
10 C,
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 9Z_
EXPIRATION DATE
DATE ISSUED
By
Administrative Authuray
TELEPHONE: (619) 564-2246
i.A