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3767 (2)7- ti y ! A ��! i 11�1�� i.�t i�1� qA! ��,�. �• �, ��! i � iili! � r�yll� � w� �� ii�►!is•!'r� ��! �� l�Ir �i MIS ��li !�� iY � !a � �.� �� J. 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 Subdivision Improvement Permit Class I II DATE: ', 2002 Minor Improvement Permit, Class IV LOCATION OF CONSTRUCTION"`�� f La "nta G01f ftt tft, sae W106 .J (Street address or Description of Location) PURPOSE OF CONSTRUCTION ) graftni; for Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION �119 Of *it*, 10VOCt 34" Iftu ma" DIM ION�IN STALLATION NSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE 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: 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,'iloss or damage to persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant••to"th'is`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 w/ork. Signature of Applicant or Agent Name of Applicant (please print) —r--•,._,,,Business-Address Telephone No. 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. Received by Date 3787 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED ^' By Administrative Authority Recorded by Telephone: (760) 777-7075 NOTE: 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 curllffiw and other like public works improvements in ectio DATE: _ October 21, 2002 LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION I DESCRIPTION OF CONSTRUCTION EMCL1na of site IMPOrt fill material for site qra&hcr DIMENSION OF INSTALLATION OR R cents, sidewalks, parking lots, sewers, water mains IMPROVEMENTS and APPROVED SUBDIVISIONS ubdivision Improvement Permi'lClass III Minor Improve rAwt Per Class IV X Sketch (attach SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WIL APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, an ackfilling, com- paction and placing permanent resurfacing a lacing improvements) In consideration of the granting of this a the applicant hereby agrees to: Indemnify,. defend. and save the City authorized agents, officers, representatives and employ penalties, liabilities or loss resultin om claims or court action and arising out of any accider happening or occurring as a proxi resk work undertaken under the permit granted Notify the Administrative Authorit -four (24) hours in advance of the time w Comply with all applicable City Ordinanand conditions of the permit and allLa Quinta and to pay for any additional rary as the result of this Name of Applicant (please print) Name of Contractor and Job Foreman Contractor's License No. R if appropriate) CONDITIONS** harmle against any and all loss or persons or property rsuan ication. work will be started. cable rules and regulations of the City of Signature of Applicant or Agent Business Address Telephone No. Telephone No. Business License No. Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — CI�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 No 3767 PERMIT VALIDATION PERMIT NO DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority Telephone: (760) 777-7075 4,f IJU IA TIM .. r+.w+......r +a�.....r....-,,....► .w....�.rwa +� ....tea. _ _ - „� NOTE: } With proper'validation 'x this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT g } 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 A MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement Permit Class II I DATE: ��. 2002 Minor Improvement Permi Class IV x LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION PreC " cWadinq for Sketch (attach DESCRIPTION OF CONSTRUCTION ("MMnOr •AT Site. iiC►POKt ' fill material for site E **S DIMENSION OF INSTALLATION OR REMOVAL. P SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK -WILL DEG, APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and.de ris, backfilling, com paction and placing permanent resurfacing as or replacing improvements) In consideration of the granting of this permit, the applicant hereby agrees to: r ' Indemnify, defend, and save the City, its authorized agents, officers, representatives and employ( penalties, liabilities or loss resulting from claims or court action and arising out of any accide( happening or occurring as a proximat�sult of any work undertaken under the permit granted Notify the Administrative Authority at�J ast\twenty-four (24) hours in advance of the -time whihi Comply with all applicable City Ordinances, thet rms and conditions of the permit and �al,l/a�ipl La Quinta and to pay for any additional replacement necessary as the result of this wort/ Name of Applicant (please print) Name of Contractor and Job Foreman 1 Contractor's License No. I Applicant's Insurance Company struction lans if appropriate) AL C`.ONDITICNS** cN es, harmles <o. a against any and all it loss or damage to persons or property rsuant-fb thi(s ap lication. ,n work will be started. icable rules and regulations of the City of_ Signature of Applicant or Agent Business Address s 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 Inspection Fee $ Permit Fee u = Penalty , Cash Deposit -Surety Bond if required TOTAL: $ Receipt No. Received by Date Recorded by Telephone No Telephone No. "City Business License No. Policy Number 3767 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE i • DATE ISSUED By Administrative Authority Telephone: (760) 777-7075 I. VP 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 cohnec'"� do with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement. Permit -1 Class III DATE: OCtobex 21, 2002 Minor Improvem nt Permit Class IV X LOCATION OF CONSTRUCTION RWi4am" I a=V WaXTIW 49128 Avenida (Street address or Description of Location) PURPOSE OF CONSTRUCTION lei: 9KI&2 � Sketch (attach co struction , lans if appropriate) a single fa%Uv residence '. i . DESC��-�R. IPTION O -CONSTRU TION >� Of Site-, nlattr87. for tA ** CQVDI'ii6S�" DIMENSION OF INSTALLATION OR REM'OVAL.f i SIZE OF EXCAVATION, IF NEEDED . APPROXIMATE TIME WHEN WORK WILL B•EG:LI\I� APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, anAebr�backfilling, com paction and placing permanent resurfacing a, d&/orlr-."replacing improvements) In -consideration of the granting of this •eermit, the applicant hereby agrees to: Indemnify, defend -and save the City, its authorized agents, officers, representatives and employ( penalties, liabilities or loss resulting from claims or court action and arising out of any accider happening or occurring as a proximate result of any work undertaken under the permit granted Notify the Administrative Authority- Nt - ast. twenty' -four (24) hours in advance of the time wh Comply with all applicable City Ordinances; theeterms and conditions of the permit and all La Quinta and to pay for any additional replacement' -•necessary as the result of this work Name of Applicant (please print) Name of Contractor and Job Foreman Contractor's License No. • r , harmlessss Ord against any and all loss or damage to' persons or property 'rsuantlib'*fr ap�lication. work will be started. ble rules and regulations of the City of, Signature of Applicant or Agent Telephone No Business Address ;•. Telephone No. �' �,, ,"w'' `City Business License No. Applicant's Insurance Company r_ 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 Inspection Fee $ t Permit Fee 1 Penalty f ~' Cash Deposit -Surety Bond, if required TOTAL: $ Receipt No. Received by Date Recorded by 375ftT PERMIT VALIDATION PERMIT NO. DATE APPROVED . EXPIRATION DATE rDATE ISSUED By Administrative Authority { Telephone: (760) 777-7075 A 6 ._ ._ _.� ..... .f...� _ �.. . .f t -S .; i. -' _ ..4 �..L...i'...Y _: -.-- 1. ....�v. .-i.a�. - ..;.�NS� M..k. �..}if•. �.' _. .. '.-:� .: - ...:��v-1 •,4 is ��1�r -- 1 � � 1..:. !F ,yp,• '� 'S - T .. - , - , v+v; — dA+PaCL�+ .., . 11 .... ,"r•'f 'ec, �^►s ,-: Wh , RF?11w-rr.-1!,1!1i:;1. i9tR1P - i..± I ' 1 it ` NOTE: 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 corinec o with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS DATE Octobz 21, 2002 LOCATION OF CONSTRUCTION (Street address or Description of Location) Subdivision Improvement Permit ` Class III Minor Improvement Permi Class IV X Worniiw 49128 11<vwdds Fox PURPOSE OF CONSTRUCTION P Sire for a soli family relsidwAx DESCR PTION OF CONSTRUCTION ftnq Of 8'Gr XJLI. m tWIA1 � 3:tS MENSION OF INSTALLATION OR RWOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN,.. Sketch (attach construction plans if appropriate) i� s� �►xr a�a�cxvs** APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, andYdebris backfilling, com- paction and placing permanent resurfacing and/or d/or replacing improvements) In consideration of the granting of this permit, the applicant hereby agrees to: Indemnify, defend -and save the City,,oits authorized agents, officers, representatives and employe penalties, liabilities or loss resultingtfrom claims or court action and arising out of any accider happening or occurring as a proximate result of any work undertaken under the permit granted Notify the Administrative Authority at least twenty-four (24) hours in advance of the time whihr Comply with all applicable City Ordinances h "terms and conditions of the permit and all afpl La Quinta and to pay for any additional replacement necessary as the result of this wort harmless frd against any and all loss or damage to persons or property irsuant4to"th'iMp'pl ication. I ork will be started. ble rules and regulations of the City of Signature of Applicant or Agent Name of Applicant (please print) Lam" -""`Business -Address Telephone No. Name of Contractor and Job Foreman Business Address Contractor's License No. Telephone 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. Received by Date � 376? PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority Recorded by Telephone: (760) 777-7075 W