2086NOTE:-
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
One Trip - OVERSIZE LOAD PERMIT
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 II
DATE: 2/28/94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Move Equipment
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 235 Backhoe
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
Sketch (attach construction plans if appropriate)
Haul Route: Sinaloa to Ave 52
to Jefferson to Ave 54 to Madison
to Ave 58
Raul Date: 2/28/94
D 3-k' �
Fie 2 8 1994
By
(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 'r an ud all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, .loss or damage to persb k� r proper
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.
or
ignature of Applicant or Agent
Jones Brothers Construction 85-989 Ave 52 347-2291
Name of Applicant (please print) Business Address Telephone No.
Mike Jones
Name of Contractor and Job Foreman Business Address Telephone No.
406921 153
Contractor's License No. City Business License No.
Sfigini & Hannon 86 FJ 954610
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 costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 10.00
$10.00
Received by Date
PERMIT NO
PERMIT VALIDATION
2086
DATE APPROVED 2/28/94
EXPIRATION DATE 2/28/94
DATEISSUtD 2/28 94
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
8
a ,,
::;?:.FEB 25 '94 1453 6193982012 JONES BROS. P.2i2
Owl
•
With: PfCPeI'.VAIidaIQn -�
this. formoaruititrmi an CIT OF LA QUINTA
en>rroacfimant germit
APPLICATION FOR PERMIT ipt PUBLICWORKS CONSTRUCTION (ENCROACHMENT)P dvertsizes ("A-0
... For.. 1 e- construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other.l.iko. public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDfVISIONS
HATE' 4-,4�2t
LOCATION.01F CON5TRUCTION
Subdivision Improvement Permit — Class III
-y-- Minor Improvement Permit Class IV
161toot WilPst:0 Deibdption.of Location) —
PURPOSE OP'CONSTRUCTION
DESCFi9PTION OF CONSTRUCTION f.Y;Ca A )G AnQ
DeilENsloN � of INSTALLATION OR REMOVAL
�.� t r
Sketch (attach construction plans if appropriate)
SIZE:OF EXCAVATION, IF NEEDED -lee,
APP90XIMATE TIME WHEN WORK WILL BEGIN -9"
APPROXIMATE TIME OF COMPLETION
ESTIMATEO.CONSTRUCTION COST.$
(Including removal of all obstruction,. materials, and debris, backfilling, com-
paction and placing perrhanent resurfacing and/or replacing improvements)
In cons.idsration of the granting of this permit, the applicant hereby agrees to:
Indempify, defend ",save the City, its authorized agents, officers, representatives and employees, harmless from and.against any -and all
penalties, liabilities or lass resulting from claims or court action and arising out of 8ny accident, loss or damage to persons or property
happenjAg or occurring as a ,proximate ru$uit of any work undertaken under the permit granted pursu8nt to this application..
Notify lite Administrativq Authority of least twenty-four (24) hours in advance of the time when work will be started,'
Comply with .all applicable City Ordinances, the farms and conditions of the permit and all applicable rules and regulations of the City 'of
14 Quinta and to pay for any additional replacement necessary as the result o�this work
Ignature of Applicant or Agent -'
cogen 2 ' �o-r� K - e ms 3�� -P-ari I
Nance 06 Applicant (please print) Business Address M Telephone No:
Namc.of Contractor and Job Foreman
44
Cbntractor's License No.
Com.._ s it
Company
FEES. Subdivisibn improvement Permit — Class III
Business Address
Telephone No.
City Business License'No.
j J^ tI*
Policy Number ...T
Public improvements: Wof estimated construction costs
Private improvements: 3% ofestimated construction costs
Minor.ImprQaement Permit — Class IV: See attached schedule
Inspection fee $
Permit Fee
Penalty
Colt Deposit -Surely Bond
if required ........
TOTAL,: $
Receipt No.. .....d _...,�...",�„
Received by 4.�.�_,,...� Date
Recorded by
Extended Page 2.1
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 2
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE, 1619) 564.2246
AdministrativeAuthority
41