2159"'WOTE�
With 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
Subdivision Improvement Permit —Class II I
DATE: 5_4-94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 50 Nest of Dans Palma b Miles
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 980 Loader
DESCRIPTION OF CONSTRUCTION
Sketch (attach construction plans if appropriate)
JEBBERSON SO TO MILES WEST TO
9= PALMS
DIMENSION OF INSTALLATION OR REMOVAL 15"19. 11"61' W
60L 61,000 lbs. D
SIZE OF EXCAVATION, IF NEEDED Y 0 2 1994 I
APPROXIMATE TIME WHEN WORK WILL BEGIN HAUL DATBt 5-4—`'Y _
r'
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ A.• `
r
(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.
A N
Comply with all applicable City Ordinances, the terms and conditions of the permit and all ap cable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result - this w k.
Signature of Ap ficant or Agent
TOP CAT EQUIP. RENTAL 2400 W. BASELINE, S.AN'Bernardino, CA (909) 888-6332
Name of Applicant (please print) Business Address Telephone No.
JOEY RBYE'S SAME +i
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. - City Business License No.
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 2159
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
!)P 10.
$ 10.
Received by Date
PERMIT VALIDATION
PERMIT NO. 2159
DATE APPROVED 5-2"94L/
EXPIRATION DATE
DATE ISS ED 5-2-94
By
oclministrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE:
With proper validation
/// this form constitutes an CITY OF LA QUINTA
( encroachment permit v
APPLICATION FOR PERMIT
PUBLIC -WORKS CONSTRUCTION (ENCROACHMENT)
oP
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
i and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit —Class III
DATS4
J Minor Improvement Permit Class IV /
LOCATION OF CONSTRUCTION
i
i (Street address or Description of Location n n
PURPOSE OF CONSTRUCTIOFIE
JV Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION y—il e(Q $ClY/ -co 7 o
DIMgN ILNOF IfV I�O`AL6�OR REMOVAL ISN I(t&r W /ms
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ f
(Including removal of all obstruction, materials, and debris, backfilling S�
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 (241 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 t is work.
A / ` Signature of Applicant or Agent
Name of Applicant (pl ase pint) Business Address Telephone No.
Name of eontractor ancyfob Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
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.
Received by Date
Recorded by
2159
PERMIT VALIDATION
a(S5
PERMIT NO.
DATE APPROVED Z
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (61b) 564-2246
Administrative Authority
0