3398NOTE:;
W# 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 II I
DATE: 119101 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION C/O AVENUE BERMUDAS AND AVENUE MONTEZUMA
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION RAISE FACILITIES TO NEW GRADE Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION SPLICE PIT REQUIRED TO
RAISE %T TO GRADE
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ASAP
APPROXIMATE TIME OF COMPLETION 7 DAYS AFTER START DATE
ESTIMATED CONSTRUCTION COST $ 700.00
(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:
SEE ATTACHED CONDITIONS
SEE ATTACHED DRAWINGS
WO 05439p000gr-010
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.
F&I,-; 14) & .�
Sign t re of Applicant or Agent
RrT .TNC 11201 k#ARRE1. STREET MTRA LORA. CA, 91752
Name of Applicant (please print) Business Address Telephone No.
LARRY WILSON 760 343 3334
Name of Contractor and Job Foreman Business Address Telephone No.
47A'SA7
Contractor's License No.
City Business License No.
Applicant's Insurance Company Policy Nu r 9 r
FEES: Subdivision Improvement Permit - Class I II
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
Recorded by
$ tnn nn
20.00
$ 120.00
Date
MAR 2 1 2001
UITY OF LA Ol1INTA
FINANCE DEPT
PERMIT VALIDATION
PERMIT NO. 3398
DATE APPROVED
3/6/O1
EXPIRATION DATE 4/30/01
DATE ISSUED 3/6/01
)Administrative AAhority
Telephone: (760) 777-7075
NOTE;
With proper yalidation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
Fur 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: 03/02/01 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION C/O AVENUE BERMUDAS AND AVENUE MONTEZUMA
IStreet address or Description of Location)
PURPOSE OF CONSTRUCTION RAISE FACILITIES TO NEW GRADE
DESCRIPTION OF CONSTRUCTION SPLICE PIT REQUIRED TO
RAISE XT TO GRADE
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
Co�Y P/%ro45
SEE ATTACHED DRAWINGS
APPROXIMATE TIME WHEN WORK WILL BEGIN
ASAP W.O. # 0543-9P000GR-010
APPROXIMATE TIME OF COMPLETION 7 DAYS AFTER START
ESTIMATED CONSTRUCTION COST S 700.00
(Including removal of all obstruction, materials, and debris, backfillirig, eom-
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 of 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 1241 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 Ouinta and to pay for any edditkmel replacement necewry as the result of rk.
Sig ture of Applicant or Agent
11201 HARREL STREET MIRA LOMA, CA". 91752
Name of Applicant (please print) Business Address Telephone No.
LARRY WILSON 760/343-3334
Name of Contractor and Job Foreman Business Address Telephone No.
CA 378587
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: $
/►
Z f// f90
Receipt No.
Received by
Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By sT
�R;W,ef
TELEPHONE: (6191564.2246
r
Administrative Authority