1746rt
i; With proper validation
this form.;constitutes an. CITY OF LA QUINTA '
encroach ment.permit
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
t
Subdivision Improvement Permit.= Class III
`: 5-2.1-93
.' DATE. Minor Improvement Permit Class IV
n LOCATION OF CONSTRUCTION
(5tree6,address or Description of Location) :
Move Equipment. .
PUAVOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate).
' . DESCRIPTION OF CONSTRUCTION eastend of 58th to'the quarry project''
1' .
DIMENSION;OF INSTALLATION OR REMOVAL width 11 .
a, aLl.'eree legal
SIZE OF EXCAVATION, IF NEEDED
f .
APPROXIMATE TIME.WHEN WORK WILL BEGIN 5•-21-93
11. 93 i0's4U1
APPROXIMATE TIME OF COMPLETION.
ESTIMATED CONSTRUCTION.COST $''
(Including removal of. all 'Obstruction, materials, and debris, backfilling, com-
as :
pactlon�,and; placing 'permanent resurfacing and/or replacing improvements)
In consideration of the granting of this. permit, the applicant hereby agrees to:
fnd6rnnify, 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.
i
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 rulers and regulations of -the, City;of.
La':Quinta �ancl jo• pay for any additional replacement necessary as the result • t is work..
u. '• "�� Signatur of Applicant or Agent
::3ameb Simon to: P.O. box 10990 Indio. CA 34.7-5399
Nae of Applicant (please print) Business Address Telephone No
Name
Name•'.of'Contractor and Job Foreman' Business'Address Telephone No.
.52 9s, 1217
Contractor's License No. City Business License No.
Applicant s'fnsurance-Company Policy Number
FEES"Subdivision'Improvement'Per,mit = Class l l l
'Public improve ments;:;3% of estimated construction costs
Private improveriments:.3% of estimated construction. 'Costs
Mlnorl'm r'yemen''t Permit —Class IV: See attached schedule
P
Ins a cti n'Fe
P
e o ee
1 $ PERMIT VALIDATION
10 .
Permit Fee PERMIT NO. 1746 ,
'• ..4. ,
Penalty 5 21-93 F.
Cash Deposit=Surety Bond DATE APPROVED y "
if required' EXPIRATION DATE 3 ' 5-21-93
-10
TOTAL: $ DATE IS UEUf:! 5-41-93
Receipt No.•': {.
By ,a
Received by' Date Administrative Authority
Recorded by. 4 TELEPHONE: (619) 564-2246
NOTE.,
With proper %dididon
this form consuvum an
rtterafth" ant permit CITY OF LA OUINTA
APPLICATION FOR PERMIT
'PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the e0111thvodon of public or prima curts, dr ways, pitygmenH. aldawaUta, O&Wr.p top, stream, Water "wing
and other Ilia publlo Maris Improvsnwttr In comtivotl0n wish MINOR IMPROVEMENTS and APPROVED SUBOIIVIRIM
r•
& bdhlltlml ImproAhlignt Panrk — Mesa Ill
DATE: Minor ImWommat Parent Class; IV �.,,.�..
LOCATION OF CONSTRUCnoie _ __
l81ran sotlraf or 0acripttan of Laottbal
PURPOSE OF CONSTRUCTION &etch (attach ooettruutlon plant If appMorig")
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLi1T30N OR REMOVAL
of -
SIZE OF EXCAVATION. IF NEEDIER
APPROXIMATE TIM9 WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COAAPLFnON
ESTIMATED CONSTRUCTION COBi' II /
(Indud" removal of all obttruodoru, moterlals, and debris, beckfilllrsw ootft•
ItWon and PMr4 permanent resurfacing and/or faolaoing Imptoyame O)
in corwk& tion of the ItaMUtp 0f thie 04111111% *0 41139110M hareby aFm tot
I Wmmify,,dafww and eaw Ma city. is autlte,krd aper, atflma, rgraNmatl.s anq amWwaa, harnim ft m am apalttrt aatr and all
pr►Ntiet. W311111aa or Igo rMICIrat trmr deft or own adlan SW Grit M out of any watdam. Ion of d~ to precise wpmom
hx" or oa mag u a pmAnI b taauh of gay wom wdwtak n undw tie pannA Fw"d (ewmom to mle ati Wathm
No" tM AdminWrit Wa AUMM Al 104 %iniydour 1g4I haun to ed, L- of lira time *k vuertr.wu t» atartaL
CwT*T wdtk atl appupaga qty Onita o", ala tonne and oenmdona of tit prink a nue/ sae mot tics � H
4 Gvifln and t0 rev for any adtlidaaal apiaw,"M tim Moy o a1u rearlt t,
of Appliewtt (plum print)
Business Addren
NIL
Nave of Contreator and Job Foonien Su elmu Addrm Telaphona No,
-- 4 . e
Centre is Llcanta
Clty Bit> Am Litems No.
Applicant's Inauranta Company -
Pollw Number
FEES; Subdtrltion tmprovamant Pernik — Clsp l{l
Public Improvementzt 3% of aW... w contI nnedom dp>itr
Private Improvements: 3% of Wmated wArlAwdon conn
V'
Minor lmpravamant Permit — Clea IV l 941 atnded schadule
Fee $
Perms Pa
Permit foe
PERMIT VALIDATION
Y
PaaaltY , '
PERMIT NO,
Cub Oeposh4uray 139no-
MATE APPROVED
It ngtpred
EXPIRATION DATE
TOTAL; tt
Raaalpc AIG. '
DATEISBUED. ,
Rard by Date,
Adminkuvgw Authority
Recoeorded by
TELEPHONE; (GIB) 6t1442;4e .