1878Li
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
C✓ X-kns \--\b\
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: 9/13/93
LOCATION OF CONSTRUCTION NI Washington NS Rwy 111
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION TO ConstruCt Due ghelt*r
DESCRIPTION OF CONSTRUCTION 10X20 C*Mt pad with
fabricated bus sbeltar to instalisd on it
DIMENSION OF INSTALLATION OR REMOVAL103L209
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ASAP
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
SES ATTACH CONDITIONS
APPROXIMATE TIME OF COMPLETION 30 days of wsit
ESTIMATED CONSTRUCTION COST $ 12+0'
(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,
Signature of Apocant or<gent
S=rise Media 303 W. Indian Canyoa Dr Pala Sprinxe 325-7078
Name of Applicant (please print) Business Address Telephone No.
Dave May Concrsts 67330 Quito Ito !a►thedral City 327+-4849
Name of Contractor and Job Foreman Business Address Telephone No.
441265
Contractor's License No. City Business License No.
Nortbbrook Property 6 Cas BPP0554795
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 $ 40.00 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
10.00
TOTAL: $ 50.00
Receipt No
Received by
Date
PERMIT NO.
PERMIT VALIDATION
1878
DATE APPROVED 9/16/93
EXPIRATION DATE 9/30/93
DATE,ISSUED
Byrvt } Zug
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
it -0
NJTE:
With proper validation
this form constitutes an
encroachment oermn CITY OF LA QUINTA
APPLICATION FOR PERMIT
•PUBLIC . WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lou, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
X Septemba- 1993 SubdivisionlmprovementPermit— Clasalll
DATE:— _..,� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION -- IVR ;n AgHT GT -0N NS HIGHWAY 111
(Street address or Oescnouon of Location)
PURPOSE OF CONSTRUCTION In r-nnci-riirt Blas Shelter
X DESCRIPTION OF CONSTRUCTION 10 u 90 rament pad
roilh fahrir-atari hits, Ghal tar to be'
i ectal 1 ar9 >>nnn i t
DIMENSION OF INSTALLATION OR REMOVAL--_.
SIZE -OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
�A co AJD I Ti °'"1 S
>4- APPROXIMATE TiME WHEN WORK WILL BEGIN
a- gnnn ac ntarmit is annroved
APPROXIMATE TiME OF COMPLET10N -Within 30 days of permit
S( ESTIMATED CONSTRUCTION COST S c 9. n n n
(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:
CM OF LA QUINTA
SEP 1 019913
PUBLIC WORKS
Indemnlfy, defend and save the City, its authorized agents, officers, representatives and emplovep. harmless from and against any and Or l
al
penalties, liabilities or lose resulting from cisum Or Court action arf0 arising out Of ally aCCrdent, loft
happening or ocCumno as a proximate rmh of any worfi undertaken under the pernit granted pursuant to his to persons w properev
applicatgn.
Notify the Administrative Authority at least twenty -tour 1241 hours in advance of the time whM will be started.
Comply with all applicable City Oldkuln m. the tamtf and conditions of the Pelm�11 appy les
La Ouints and to pay for tiny sddltkM* replacement n regulations of the City of
��y es the result of
Name of An licant ( I
of Applicant
In Dr. Pa]Lm rings, 325-7078
p pease pant
Bus
fiess Address
Telephone No.
Dave May Concrete 67330 Oui'o,Road.Cathedral City 327-4849
Name of Contractor and Job Foreman
Business Address Telephone No.
�C #441265
Contractor's License No. City Business License No.
X Northbrook Property & Cas BPP0554795
Applicant's Insurance Company G-2 EWEiZA L Policy Number
FEES: Subaivlsion Improvement Permit -Class III / f0(L (a(�F�z�2t�1Cn USS ofJLY
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor improvement Permit—'C1lass IV: See attached schedule
Inspection Fee $ i D
Permit Fee 10 9
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$� 15 0
Receipt No.
Received by Date
Recorded by
M
PERMIT VALIDATION
PERMIT NO. J-8-78
DATE APPROVED �1 16 - CI-3
EXPIRATIONDATE ' 3 D - l 3
DATE ISSUED
By
TELEPHONE: (619) 564.2246
Administrative Authority
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