1818NOTE:
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
DATE: 7-27-93
LOCATION OF CONSTRUCTION 52-525 Navarro
(Street address or Description of Location)
PURPOSE OF CONSTRUCTIOMewer connection
DESCRIPTION OF CONSTRUCTION installation. of aeropr
lateral in -City Right -Of -Way
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
See attached Drawing
DIMENSION OF INSTALLATION OR REMOVAL60 L.F.
SIZE OF EXCAVATION, IF NEEDED 21 wide 3' deep
APPROXIMATE TIME WHEN WORK WILL BEGIN 7-27-93
1
A
APPROXIMATE TIME OF COMPLETION 7-29-93.;/V
ESTIMATED CONSTRUCTION COST $../
(Including removal of all obstruction, materials, and debris, backfilling, com- By 7— 1
paction and placing permanent resurfacing and/or replacing improvements) i
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 is work.
Signature of Applicant or A ent
Hendrickson Construction 68-365 Kiely Rd. Cathedral City, CA 328-1747
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
654167-A
Contractor's License No.
on file
194
City Business License No.
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
r Received by
Recorded by
I
$ 30
$ 30
Date
e
PERMIT VALIDATION
PERMIT NO. 1818
DATE APPROVED 7-29-93
EXPIRATION DATE 7-30-93
DATE ISSUD 7-27093
By
Administrative Authority
TELEPHONE: (619) 564-2246
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NOTE:
With proper validation
this form Constitutes an CITY OF LA QUINTA
encroachment 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
,J. -
*2_ � 7 ! Subdivision Improvement Permit -- Clis, ill
DATE: ( Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION , 22-5- • A- C= s-, K),4 j ,a. v'-�2
(''ice r:A L.r _C4,& A) tc 1 Ajar -i-- _ AJ S_= w.1 A—ss-A-
ISuht addreu of 0614tiotion of LocsticAl
PURPOSE OF CONSTRUCTION � W a,- e& �bo Sketch (attach construction plans if approWis s)
DESCRIPTION OF CONSTRUCTION �' pT2�►�iN' � '`� I`�C"
DIMENSION OF INSTALLATION OR REMOVAL 1<
SIZE OF EXCAVATION, IF NEEDED t3LZ o�
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 77- -9 3 _ _
ESTIMATED CONSTRUCTION COST S / (_, l Y 0 �-
flncluding removal of all obstruction, materials, and debris, backfilling, com- 1`
Auction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrers to:
Indemnify, dafand and save the City, its author+ted ag.rru, of en, rep►ri eitsoy s and ernploym, harmless from and against env aria all
Demise%, Ilabtlhlat Or lea resulting from claims of court action and arising out of any accident, loss or damage to corona or property
haowirp or occurring at I proxiRlaq emit of any v-00ft WKI"ten under the permit granted pursuant to this appli stion.
Notify the Administrative Authority at least twenty -lour 1241 hoot A 64vanes of the him» when work will be nareaa,
Comply with all applibbla City Ordinenan, the terms and'eonditloro of the pertnrt and all applicable rules and ngulatlons of the City of
U Write and to pay for env additional rtrp K*ffom neceesary at the result of this wok.
I t r. _ Signaturt of Applicant or Agent
Name of Contractor and Job Foreman
Contractor's License No.
Telephone No.
/9zl
/ 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 cents
Minor improvement Permit —Clan IV:
InSpeCtlOn Fee Sy-0
Permit Fee
Penalty
Cash Oeposlt-Surety Bond
if required
TOTAL;
Receipt No.
1a
See attached schedule
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO, eq 18
DATE APPROVED _ 7r
EXPIRATION DATE -_7 - 30 9
DATE ISSUED _ % ' 27 _'* 3
By
Administrative Authority
TELEPHONE: 16191 684-2248
` ' 5r