2264NOTE?
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
Subdivision Improvement Permit — Class III
GATE: 11-28-94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Jefferson St. Avenue 50, & Avenue 52
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 10k run—Tamale Festival
road race on Dec. 3, 1994
DESCRIPTION OF CONSTRUCTION Street coned off for
running lane & Barricades at corners
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
7:00 am
APPROXIMATE TIME OF COMPLETION 9:00 am
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)
See attached course layout
Permittee shall be responsible for
restoring thesite and all streets to
the original condition
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.
Signature of Applicant�or Agent
Coachella Valley Recreation & Park District 45-871 Clinton Indio, CA 92201 347-3484 ERT 114
Name of Applicant (please print) Business Address Telephone No.
Laura McGalliard
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
California Association of Recreation & Park District Insurance
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111 p,, �
Public improvements: 3% of estimated construction costs �/`
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule ` 2254
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10 2264
PERMIT NO.
Penalty DATE APPROVED 11-28-94
Cash Deposit -Surety Bond
if required EXPIRATION DATE 12-3-94
TOTAL: $ 10 DATESUED 11-29-94
Receipt No. 'k,
Received by
Recorded by
Date
BY
0 Administrative Authority
TELEPHONE: (619) 564-2246
r -------------
NOTE:
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
DATE
LOCATION OF CONSTR
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
'VOA Sketch (attach construction plans if appropriate)
DIMENSION OF INSTALLATION OR REMOVAL
&&M4W-*E61
1
auRs�
T'T lid s t-� A 31�z I�z� oNS l 13 tri.
SIZE OF EXCAVATION, IF NEEDED �smm� P 3
t O_- 71 -k -C. -LVA-0 -1,4FA.hSS� 2�vgTv2
APPROXIMATE TIME WHEN WORK WILL BEGIN �- TWle- s r1 -e- -Ca *�
0-0 OJ D VT l f9K]le
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ r n
(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.
r
djdnaii
1nho)lu V/1f lAi�� �or>P.,�i�n lh 01/ fl c-� I.�- li t r'9e f�
Name of Applica�nnt (please pri6k) Business Address Jl'VV fv L.4 -f -,,Telephone No. i y(
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. A
City,Qu;inpss Licepse No._ w . t _ _
Applicant's Insurance Company / Policy Number
FEES: Subdivision Improvement Permit — Class I I I
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
PERMIT NO.
.. ATION
DATE APPROVED X%-Z� r9T t/
EXPIRATION DATE �Z 9 7
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
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