2076iN:
__iNith 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
2/23/94
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 77-625 Calle Hidalgo
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Extend Sewer lateral with
no connection to house sewer
DESCRIPTION OF CONSTRUCTION Dirt trench 3'to6' deeg
X60' L infront of uronerty on Hidalgo. lap 60' of
4" ABS Dive.
DIMENSION OF INSTALLATION OR REMOVAL Trench 3' to 6'
Deev. avvrx 2' W. 60' L.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 2/24/94
APPROXIMATE TIME OF COMPLETION -1 week
ESTIMATED CONSTRUCTION COST $ 300_00
(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:
Sketch (attach construction plans if appropriate)
UEZ-ATTACHED CONDITIONS.
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 wlje work wi I be started
Comply with all applicable City Ordinances, the terms and conditions of the a mit fid a applicable rulesland regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of thi, w9
Signature of App ican cigent
Michael E. Head 77-625 Calle Hidalgo, La Ouinta 564-1618
Name of Applicant (please print) Business Address Telephone No.
Owner? Builder
Name of Contractor and Job Foreman Business Address Telephone No.
N/A N/A
Contractor's License No. City Business License No.
State Farm Ins. `� 55-E8-2106-9 F
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
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:
$ 20.00
10.00
$ 30.00
Receipt No.
Received by Date
1;
PERMIT VALIDATION
PERMIT NO
2076
DATE APPROVED --2/291/94
EXPIRATION DATE 3/4/94.
DATE I qSI IFD — z's q
By 29&44/I`4a11y_
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
= ---------------------------------------------------------------
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
a
3 Subdivision Improvement Permit — Class 111
DATE: Cj
9 "\ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION �, 7 `2— S
c,r+ c 3
(Street address or Description of Location)
PURPOSE OF CO TRI.(, ION
SCRIPTION OF CONSTRUCTION
tf„ ASS- . iT-
IC
DIMENSION' icy QF INSTALLATION OR EMOVAL '7—^ —
,3 6' IVB f) , APx z'w0,'-z_ A 66�—
SIZE OF EXCAVATION, IF NEEDED
AP7OX)MATE TIME WHEN WORK WILL BEGIN Z 9y
/4, RU
/ ZLj1ZrZ_k-
Sketch (attach construction plans if appropriate)
p�iT.� �c-F c� cd�rfJ I"Tlo °S
I% �` #..
r 6Q�
s--------j�--- o �m
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ � ? '�-) 04 �h�, r�lRlC,�
(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 the7peit and plica le d regulations of the City of
La Quinta and to pay for any additional replacement necessary as the resultis wo
i
Signa ure of Applicant or Agen
7? -K2
Name of Applicant (please print)
Business Address
6u-16) 9,
Telephone No.
.� � lLl/n./E�/f3ti I Ltd 2
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
S�i4'%G �i42M
Applicant's Insurance Company
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
I Y n r.. $ -t®
nspec to
Permit Fee
`L)
Penalty
Cash Deposit -Surety Bond;
if required
TOTAL: $ 30
Receipt No.
Received by
Recorded by
Date
City Business License No.
Policy Number
. _.....TION
PERMIT NO. �� c,7
DATE APPROVED 2 -7,3— 9 `f
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 52246
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t