2970NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
i
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: 5-14-99
LOCATION OF CONSTRUCTION La Quinta 'Library
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
78-080 Calla Estado
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION ' Dedication of Remodeled Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Street Closure in front
of Library per Traffic Control Platt Sec attached conditions
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 5-17-99
APPROXIMATE TIME OF COMPLETION 5-17-99
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing arid/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. /
-Signature of Applicant or Agent r ��
La Quinta Library 78-080 Calle Estado La Quinta, CA 92253 (760) 564-4767
Name of Applicant (please print) Business Address Telephone No.
John Walker
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
ft t
Applicant's Insurance Company Policy Number
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
nspec'ti n Feee $ 284.00 Equipment Rental II
Permit Fee
Penalty
Cash, Deposit -Surety Bond
if required
TOTAL
Receipt No.
100.00
50.00 Traffic Plan
95.66 Set-up/Removal
$ 529.66
Received by Date
FAD
2970ar i 7 1sss
PERMIT V)jlI� l A IA1TA
PERMIT NO. k2970 �V 1
DATE APPROVED 5-14- 99
EXPIRATION DATEy� 5--'31--99
DATE IS SUED'
By
Administrative Authority
Recorded by
Telephone: (619) 777-7075
SPECIAL CONDITIONS -- PERMIT NO. 2970
--- La Quinta Library ---
This permit authorizes work to be accomplished within City of La Quinta right of way ONLY. Whenever
activities extend into private property, it is the responsibility of the permittee to secure permission from
affected property owners. Such authorization must be secured by the permittee prior to beginning work.
1. Streets shall be kept clean. They shall be completely cleaned at the end of the event and more
frequently if required.
2. Permittee shall assume responsibility for repair of any damage to public or private streets and for
any damage to other City -owned facilities as a result of activities performed under this permit.
Special Conditions - Permit No. 2970 Page 1 of I
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA <<'
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
C`n`�OF THE��
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: 2"J 7AT � Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION L ASLS u�.y-r* %C:L !9 L-t. i 2 ) te%EA J23
ova CAI.t_frrsneo�
(Street address or Description of Location))
PURPOSE OF CONSTRUCTION k ZIP / C-214 7-2 V 4- Gam= Sketch (attach construction plans if appropriate)
a
DESCRIPTION OF CONSTRUCTION x4 V
Li y C'f-e-AI,PPS '
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED ' A' ,)
APPROXIMA,qTE TIME WHEN WORK WILL BEGIN
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:
Iridemnify, 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,124) 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.
Signature of Applicant or Agent
=If
4�.4 �� L� nrLT� Business
c�L���r�oan s'b�- �+yi>
Name of Applicant (please print) Business Address Telephone No.
t s1`p L-
,3'-V �n� t2 - -L+J.o � 4 � ,fir • % 9 - c� Ss a - GoLus �3� a
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 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.
2774
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Received by
Date
Recorded by 11 - Telephone: (619) 777-7075
Administrative Authority
99
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