2102NOTE:
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
OA0194 3/14/94
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION -_Move Equipment
5;0yTbsWeeT0H,79'81., ,
eIy14larWng g
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit —Class I I I
Minor Improvement Permit Class IV
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(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)
Park AVe to Ave 50 West to
Washington to Hwy 111.
Haul Date 3/15/94
F'
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.
IL
Signature of Applicant or Agent
Zim Industries, 4545 B. Lincoln , Fresno (209)834-1551
Name of Applicant (please print) Business Address
David R. Allacho
Name of Contractor and Job Foreman Business Address
440 — 537
Contractor's License No.
Hanover Insurance
Applicant's Insurance Company
FEES: Subdivision Improvement Permit — Class 111
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.
Received by
Recorded by
10.00
$ 10.00
Date
Telephone No.
Telephone No.
City Business License No
ZMP 345966tou
Policy Number
210
PERMIT VALIDATION
PERMIT NO. 2102
DATE APPROVED 3/14/94
EXPIRATION DATE 3/15/94
DATE ISSUEf� i` n$/14/9
li <I"J
Administrative Authority
1
TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit ' S
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
c`t'VOF THa�FS
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 III
DATE: 7 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
Sketch (attach construction plans if appropriate)
pirrk fns `i0 4ae, 5 o
DIMENSION OF INSTALLATION OR REMOVAL
i
j SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGW
APPROXIMATE TIME OF COMPLETION /
ESTIMATED CONSTRUCTION COST $
(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.
••�N� / L' Signature of Applicant or Agent , r
S L. I ,.i I.,.f o7 Q p — B'• 7 ^ / ��/
Name of Applicant (please p int) l Business Address Telephone No.
\&_-zX-LZI N w &i9 -.J f .O _ 2 o 9 ^ 6 3 /-5 "s` /
Telephone No.
4' Name of Contractor and Job Foreman Business Address
Contractor's License No. City Business License No.
�.41v m 0<42 ;r--lv Q tRu 16 IS T�
Applicant's Insurance Company C��al, 1-4Rxi(LIT�Policy Number
FEES: Subdivision Improvement Permit —Class III 7
,'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.
Received by Date
Recorded by
2006
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
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