2744WiiK p,roper•validati�on,•► 4
-this form constitutes an CITY. OF LA QUINTA
encroachment permit\ t„
;�-. APPLICATION FOR PERMIT r ��
PUBLIC WORKS, CONSTRUCTION JENCROACHMENT)
OF
For the construction of public or private curbs, driveways, pavements, sidewalks, parking+lots, sewers, water "mains
and otherjlike•public works improvements in connection `with'MINOR'IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision J imr vement Permit — Class I,I
I
I DATE: LLAgL'i�.�$4s-�$$8', -a :* # •, .°.mClass]S y,
-� •�. Min r o I provement.Permit V
LOCATION OF CONSTRUCTION %i d* Tract 24890-•
(�treet'address or Description 'of Location) '
PURPOSE OF CONSTRUCTION Sketch (attach construction'plans if appropriate)
DESCRIPTION OF'CONSTRUCTION=aatCarin
xOn
DIMENSION OF INSTALLATION OR REMOVAL' 41 + •" i '$ '% ! DU 808 fs
t r' 'PAV1=.:%&&CT 24890.
t SIZE OF EXCAVATION; IF.NEEDE.D
'APPROXIMATE.TIME WHEN WORK'WILL BEGIN :F
APPROXIMATE TIME,OF COMPLETION�� c•
ESTIMATED CONSTRUCTION COST $ -800L �' r
(Including removal,of, all obstruction, materials, and debris, backfilling, com-
paction- and placing. permanent resurfacinandl/or. rlacingeimprovements) '
In consideration of -the granting of this permit, the applicant hereby agrees.to: .t .c
Indemnify, defend;and save the City, its authorized agents, offices, 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
ccurii'
happening.or`orng•as,a proxmate
result of any work undertaken under the permit'granted pursuant,to this application. "'i t,
'
Notify 'the Administrative Authority at least twenty-four (24)'hours inadvance 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
Hanue`l Di. La''Tori , �0?9 51495 J6li6tn,6U'&t, fait Qi 7x>ca, C.lk'.. • , . !(760),.56"473 #
Name of Applicant (please print) , .'' Business Address : ! Telephone No: `.
J.1i. fi'Ih son & Baha, lua 79-698 Gabe�d A V..'' tea�tda Wtieo. C� � ���i�?� � 38�-6835
Name of Contractor. and Job Foreman Business Address ; Telephone' N,o:
7344.83 3205
Contractor's License'No. 'City'Busiriess_License No.
Itiveat o,Ira InOuranco Grdub C 10OA5►9' #
Applicant's Insurance;Company , ° + Policy Number.' APA zID'
14
? FEES: Subdivision: Improvement Permit -Class III ' ,,. i '•
iMAY 0 6 ,1998
;Public improvements: 3% of estimated construction 'costs ;
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule INT OFLA QUINTA
249.' ,.
Inspection Fee $ PERMIT VALIDATION i
Permit Fee 100' PERMIT NO. '� 77AG i..
Penalty DATE APPROVED 4/24/96 `
Cash Deposit -Surety Bond
if required EXPIRATION DATE 4%24/99
TOTAL: $ 349• DATE ISSUED
Receipt No.avl 0".11 r�jW
By
Received by Date Administrative Authority
Recorded by Telephone: (619) 777-7675
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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 '
�i �g `--
Subdivision Improvement Permit —Class 111
,'DATE: �+ /Minor Improvement Permit Class IV
LOCATION 0 CONSTRUCTION ( (� (' 0 U t'•S2 ;
L. r -ac+ ' 2 -LI -6-9 D
(Street address or Description of Location �' • .
(
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONATR YCTION
DIMENSIOtY0F INSTALLATION OR REMOVAL ,
SIZE OF EXCAVATION; IF NEEDED f/�B►^� "-I ` �MS '" I rxC+'
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION t7n I I -
ESTIMATED CONSTRUCTION COST $ ,
(Including removal of all obstruction, materials, and de ris, backfilling, com
pattion and placing permanent resurfacing and/or replacing improvements)'
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnity,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 Quints and to pay for any additional replacement necessary as the result of this work.
. 1
V Sigriatu a �fAwpplicant or Agent '2(ey-YVV0AUA To C1'r� >At � CA- qu 3 JC(,o
If
Name of Applicant (pleise print) I Business Address ,, Telephone No. �O
1, I -f TKUrV-*ose�— Z ins . c . -� P
Name of Contractor and Job Foreman Business Address elephone No.
Contrector's.Liceh City Business License No.
Applicant's Insurance Company GEN. L.IASILIT l 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 VALIDATION,,.
Permit Fee
PERMIT NO.
PenaltyLj 2
Cash Deposit -Surety Bond DATE APPROVED
if required. I Z r4
EXPIRATION DATE
TOTAL:' DATE ISSUED
Receipt No. "
• By
Received by Date w I Administrative Authority
Recorded by TELEPHONE: (619) 777-1075
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POLICY NUMBER: Q Lw1 44
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Attn: Building 8'Sat0ty Dept.
?W5 Calla Tampico'
x La Quints; CA 92253 �` � .. _ ' :; ,�. , • � �7.
} (it no,arnry appeiarts above, Information rNuired to complete thif ondursernent will be shown In the Deciaratfons�
as a plicable to this endotse:rneni.)
" a Wiii9 l;a AN il�.�iUAFQ (Section ilj ti� Amended to include as an Insured the person or orgAnir_tttinrw shown
i "tits Scht ;du, but only with respect to liability aric.,bg out of "your work" for that Imme'd by or•for yolt."
See attachoil Additional Insaured F6MI CG20101185., `
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