2130-NOTA
"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
DATE: 4/11/94
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION __Move Mobile Home/Office
2 Units
DESCRIPTION OF CONSTRUCTION Double Wide 12%
30,0001bs. 801L
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
Sketch (attach construction plans if appropriate)
Haul routes 54th to Jefferson
Jefferson to City Limits
Haul Date: 4/11/94
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 wort: 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 Applicant or Agent
Morgan Drive Way Inc. (800) 677-7623
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
Contractor's License No.
Business Address
Telephone No.
City Business License No.
Applicant's Insurance Company ember
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
10.00 + 10.00
t
$ 20.00
Date
L_"
U
2130
4 PERMIT VALIDATION
PERMIT NO. 2130
DATE APPROVED 4/11/91
EXPIRATION DATE 4/11/94
DATE ISS EDS 4/11/9
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an
encroachment oermrt CITY. OF LA QUINTA-_.
APPLICATION FOR PERMIT
-PUBLIC WORKS CONSTRUCTION IENCROACHMENT)
For the construction of public or private curbs, driveways, *Pavements. sidewalks, parking lots, sewers, water mains
and other like public works improvements in.eonneetion with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: = I/ A `'t - Subdivision Improvement Permit — clan III
Minor Improvement Permit Clan IV
LOCATION OF CONSTRUCTION
(Street address or oesagmon of Location)
PURPOSE OF CONSTRUCTION —1MOVO. �O/J� ,(I�
Sketch (attach constructionplans if appropriate)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Com/ � R..t_-��•
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction. materials, and debris, badcfilling, com.
Paetion and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indertinov, defend and saw the City, its authorized agents. officers, neoreserustim and amployep. hartiless from and against any end all
Pwultrn, labilitias or los suiting from ctsirm or cows action std arising out of any accident. toss or
to
happenrrq or oocvmrq e • Prorirmete nsuK of any work undo ken under the permit granted pursuant wento mage aopticaI pwwm « � y
Notify the Administrative Authority at least twenty-four 124) hours in advance of the time whon work wr,11 be started.
Comoly with all SPWK ble City ordomm*s, the term and canditiom of the permit and all aoOticsible rules and regulations of the C ty of
Le Quints and to pay for any additional 1`001MVIVM natassary as the result of this work.
_ A
A signage of AoWiant or Agent
Address Telephone Na
Name of Contractor and Job Foreman
Business Address Telephone No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company
Polity Number
FEES: Subdivision improvement Permit — Clatt 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
'enalty
ash Deposit -Surety Bond
f required
TOTA L. S
Receipt No.
3eceived by Date
3ecorded by -
PERMIT VALIDATION
PERMIT NO.
GATE APPROVED
EXPIRA
DATE
f
By-
DATE
- Administrative Authority '
TELEPHONE: (619) 5642246
f
r