1715NOTE: F�^.^`• �r,r `�
-With proper validation -
this form con's'titutesari-CITY OF • LA .QUINTA
encroachment permit,
,.A APPLICATION FOR PERMIT,
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
. Cep wSw
For, the construction of public or private "curbs, driveways; pavements,sidewalks, parking lots, sewers, water mains
s and other like public works improvements in connection with MINOR,IMPROVEMENTS and APPROVED SUBDIVISIONS
;;
,
hSubdivision' Improvement Permit —Class II I
DATE: `4/16/93 _ - , Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 51.798 A1vnrado
(Street address or Descriptionof Location)
PURPOSE OF CONSTRUCTION Wt. adtii* 0 Sketch (attach nstruction plans if appropriate)
•aporoAgh R ,i
DESCRIPTION'OF CONSTRUCTION PZR AWMIDE COMY STD # 207
-. DIMENSION OF REMOVAL
O INSTALLATION ` R L
O A
�r =`pSIZE'OF EXCAVATION, IF,NEEDED+
APPROXIMATE TIME WHEN.W0,RK WILL,BEGIN`-%4/16/93
£ APPROXIMATE TIME'OF COMPLETION
c t
:'ESTIMATED CONSTRUCTION 'C ST
O ;
W. (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` off icers,�representatives and employees,• harmless from and against any.and all
penalties, liabilities•'or loss resulting,.froni Aclaims' 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 `undei 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. '
r
•T Complywith fall applicable City Ordinances; the terms and'conditions of the'permit and all applicable rules andregulations of the City of
La Quinta„and to pay for any additional -replacement necessary as the result of this`work. Y ;
4*4
Signatyrof"Applicant➢or Agent �.
"' Coron*61 Coxtal `'+ . 3 PO 1�0`x 123$. 1. 041ata . 92253_ w X564•-4604
Name of.Applicant (please print) '_ + Business Address ' yR� Telephone No.
Cnxb 841/ %1
8 � ' - . <' -, �a>whatl�alCtjtq�� 321-9700
f - •7 _
r, f r.
Name of Contractor and Job Foreman-”, = Business Address Telephone No.
589084 *: - i.' • ,»i., 209
A ,Co:ntractor's License No.,' ' = rti., = fi'�"r ,' .. 'City Business License No. ^•may
$b1.�i662Q
Applicant's Insurance Company A• Policy Number' '
!'FEES: Subdivision Improvement Permit - Class'III,'• ” " _ • • .
R, 4
Public improvements: 3% of`estimated construction costs, {/palty[(�}y +�/j�[{`�"'+(jy6'93 (� f 0
•% ..4'. . i. ^' .+ �. • " . 4 l �•. . ,.l , '' ` fY[t3 A J fJI'il_ti', .4V a V V
Private•i,mprovements:'3% of estimated construction costs + ;
t Minor Improvement Permit'— Class IV: See'attached schedule
<7 ..'
• Inspectiony$Fee ` - � ' "', *''y ` ',:,� PERMIT VALIDATION
Permit Fee . ,1 20.00 10.00
PERMIT NO.
Penalty : t ;
Cash,Deposit-Surety Bond DATE APPROVED 4/15/93
.if required EXPIRATIODATE 4/23/93
. N r
$ 30.00
TOTAL: i DATE IS 4/16/.03 '
Receipt No. '
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an
encroachment permit
r 4
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks,
parking
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
v- r
DATE:— t to ct3 Subdivision Improvement Permit — Class.111
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION�— `7 Oil I�{ tJCv✓C', c.
(Street address or Description of Location) \ ,� `yam
PURPQSE OF CONST UCTION .�)� fid' `'��1 Sketch (attach construction laps if a
► �� `N P PPropriate)
DESCRIPTION OF CONSTRUCTION
�A
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN - C
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:
�lt/7vlZSi l� > �J7
(,,A -Mo- _ ( -F z
Indemnify, -defend and save the City, its authorized agems, 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 124) 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 ations of the City of
La Quints and to pay for any additional replacement necessary as the result this work.
Signature of Applicant or Agent
w �1 �r• �e� w��i. � �' o�C �23Q, l„p- C��ti..�q - ,., A
Na7!uv
1 � of Applicant (please print) 1 t� b �j
NJV Business Address Telephone No.
37j-�- ID0
Name of Contractor and Jo oreman Business Address
�alj O IR `l
I Tele hone No.
Contractor's License No.
City Business License No.
Applicants 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
X86
PERMIT VALIDATION
PERMIT NO. - 7 I S
DATE APPROVED L4— 1 � r�
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246