1726NOTE:
'r 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
Subdivision Improvement,Permit — Class I I I
DATE: 4/28/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-038 Bermudas
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move House Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Hinse on Dolles
DIMENSION OF INSTALLATION OR. REMOVAL 20x38
` ` •SIZE OF EXCAVATION, IF NEEDED
F'APPROXIMATE TIME WHEN WORK WILL BEGIN
Bermudas South Easton Ave 52
North on Washington out of City
Limits. .11
Move is to be done at night to
cause least impact on traffic.
PILOT CARS REQUIRED FORWARD &
AAT AA --''8_93 14
` . APPROXIMATE TIME OF COMPLETION 5/4/93
ESTIMATED CONSTRUCTION COST $
'n (Including removal of all obstruction; materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
11. In consideration of the granting of this permit, the applicant hereby agrees to:
li 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.
Ifs
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started. '{ r
Comply with all applicable City Ordinances, the terms and conditions
of
oPfermit
and aI
Iapplicable
rules and re uIatio
nsof the City
of
lthLa Quinta and to PaY4for an 'additional replacement necessary as the r is work.
3
Si nature of A cant or A en.t,,,.., r .
- 9 P 9
ALLIED HEAVY MOVING 2678 S. Lilac BloomfnSton CA 92316 (.909) 877-9393
Name of Applicant (please print) Business Address "" .rii,r Telephone. No.
Darrell Foreman xr'
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
On File On File
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:.
Receipt No.
$ 10.00
.Received by Date
Recorded by
�` t• ��s;J
PERMIT VALIDATION
PERMIT NO. 1726
DATE APPROVED 4/28/93
EXPIRATION DATE 5/4/93
DATE ISSUED 4/98/93
By
Administrative Authority
TELEPHONE: (619) 564-2246
f
NOTE:
«Withproper validation
this f&m.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
y.
DATE:- �Z Subdivision Improvement Permit - Class ill
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION - /?0vI_P
DESCRIPTION OF CONSTRUCTION ,�r?��CO 0110-1
DIMENSION OF INSTALLATION OR REMOVAL 3
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
- 19e*Zm vC14_f s ova 4-
F�sT oma- 3�2 A—C i ,,0*er ,( ow
Mac /-5 T6 AE ve��
APPROXIMATE TIME OF COMPLETION " /AAP A -C -r v Al � �l Fri C- ;
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com- �(LOrt G Ii=S /ZF-a14t I
paction and placing permanent resurfacing and/or replacing improvements) 2' a/LD 7} -F -Z:
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 appikcation.
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 Quints and to pay for any additional replacement necessary as the result of this -work.
Name of Applicant (please
Name of Contractor and Job Foreman
Signature of
Business Address , . Telephone No.
Contractor's License No. City Business License No.
&2q F/ L6 /V F L,
Applicant's Insurance Company Polity Number
FEES: Subdivision Improvement Permit -Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit - Class IV: See attached schedule
Inspection Fee ;" $
I
Permit Fee /0
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$
Received by Date
Recorded by )"
1x86
PEIRMIT> VALIDATION
PERMIT NO.
DATE'APPROVED
EXPIRATION DATE s - 7 - 9 3
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619),564-2246