3881a
;rt+
',DIY
f,
.V ,
1 �
NOTE:
' With proper validation
this form constitutes an
encroachment permit
0
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 alns
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIV•S(ONS
DATE: March 28., 2003
LOCATION OF CONSTRUCTION 80-420 Avenue .52, _La
/Subdivision Im
Minor I
inta
(Street address or Description of Location)
PURPOSE -OF CONSTRUCTION Off site water improvemen —
fire protection
DESCRIPTION OF CONSTRUCTION Install C offsite
water line — 18" DIP-313 LF,-18".bu erfl
valve 1' ea 8'.' valve8" detector check valve 1 ea9 f
DIM N§ION OF INSTALLNION OR REMpYAL Trencho y for
8 water main ' wide by 4 deep.
SIZE OF EXCAVATIQN; IF NEEDED 3 wide by 41 deep
313 LF of 18
APPROXIMATE TIME WHEN WORK WILL GIN Ap 1 8, 2003
:merit Permit — C ss I I I
�ement Permit lass IV
Sketch (attach cElea
tion plans if appropriate)
PLANPARATE
N,,blow of
APPROXIMATE TIME OF COMPLE ION Apri 15, 20 3 `
ESTIMATED CONSTRUCTION COS $ 35,0 .59 °
(Including removal 'of all obstruction, aterials, an debris, ba kfilling, com- ?
paction and placing permanent resurfa ing and/or re lacing i provements)
In consideration of the granting of this ermit, the ap 'ca hereby agr es to:
Indemnify,.defend� and save the City, its uthorized agents, officers, repre ntatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from laims or court action and ari ing out of any accident, loss or damage to persons or property
happening or occurring as a proximate resu of any work undertaken der the permit granted pursuant to this application.
Notify the Administrative uthority at least t enty-four (24) hours i advance of the time when work will be started.
Comply .with all applicable City rdinances, the terms and conditio s of the permit and all applicable rules and regulations of the City of
La Quinta and to. pay for -any addi nal replace nt necessary as the result of this •work. ,
Signature of Applicant or Agent
Price's Nursery and Garden Supply,.In 760-324-1226
Name of Applicant (please print) Business Address Telephone No.
Price's Nursery & Garden Supply, I 36021 Campbell, Cathedral City. 92234
Name of Contractor and Job Foreman Business Address Telephone No.
Contjfficerss License No. City Business License No: "
Applicant's Insurance Company / Policy Number
FEES: Subdivision Improvement Permit — lass II I
Public improvements: 3% of es mated construction costs
Private improvements: 3% of stimated construction costs
i
Minor. Improvement Permit — lass IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
N2 3881
PERMIT VALIDATION
PERMIT NO.
FDATE APPROVED
EXPIRATION DATE
DATE ISSUED
By.
Administrative Authority
Telephone: (760) 777-7075
I
., `NOTE: f
^ Wltli proper-.4idation .;
this form constitutes am
encroachment permit.
u
CITY OF LA QUINTA APPLICATION FOR PERMIT
,PUBLIC WORKS CONSTRUCTION (ENCROACH MENT).c. Im" "Sw
OF-T�9`v
For ;the construction of public or private curbs, . driveways, pavements; sidewalks„ parking lots, sewers, water, i•4iains•
and.other like public works 'improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIV SIONS
Subdivision Improvement Permit= C: ss.11l
March.28 2003
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION ' 80-420 Avenue' 52, La inta
(Street address or Description of Location) ,
Offsite.water improvemen N ,
PURPOSE OF CONSTRUCTION Sketch (attach co str /tion plans if appropriate) .� .
fire protection
DESCRIPTION OF CONSTRUCTION Install C offsite PLAN SEPARATE
water line '_ 18" DIP 313 LF,: 1a" bu. erfly.
valve .'1 'ea $" va3ve8" .detector check,
: vaTv2 '1 ea..� 6 � blow:of 1 ea
DIMENSION:OF INSTALLATION OR REMOVAL Trench y t.or
18'`" , water main 13' . wide. by 4 ° • deep
SIZE OF fXCAVATIQdV, IF NEEDED 3 wide by `• ' deep
,313 LF�of..18
{ :. Ap 1 8•',. 2003r': '
. IAPPR,OXIMATE TIME WHEN WORK WILL EGIN
APPROXIMATE TIME OF .COMPLEX ION Apx4 15, 2gR3 '
ESTIMATED CONSTRUCTION COSY $ ' 35,OW.59
(Including removal of all'obstruction,� terials; and\ebris, ba'kfilling, com
In consideration, of the granting of this permit, the a
Indemnify, deferid•and save the City, its authorized.ac
penalties, ,liabilities or loss resulting•from.claims or a
happening or occurring��0as.a•kproxx\imate,resulof any V
Notify the. Administrativ�Authority'at least tlnrenty=fo
Comply with all applicable City�rrdinances,•the terms
L'a Quinta and to pay for..any:8ddlfi nal-replace ent
•'Price''s Nlirsery and Garden `Si I
'• Name:of Applicant;(please print).
Pr` ice' a Nursery & 'Garden .3.upply, II
Name'of Contractor and Job Foreman ,
Contractor's License No.
ica t hereby agrees ,to:o
-
s, officers, representatives and employees, harmless' from and against any: and+all
t•action and. an Ing,out-of any accident, loss 'or damage to persons or property, \
c undertaken rider the permit granted pursuant to'this,application.
.
(24) hours i advance of. the time when work will' be started.",.
d conditio s of, the permit.and all applicable; rules andregulations C4of
ations of the ,
;essary as the result of this works,
Signature of Applicant or Agent
n 760-32471226
Business Address Telephone No;
.. 36021..Campbeil, 'Cathedral City . 92234
Business Address Telephone;No:; ,
City. Business License No:
Applicant's, Insurance Company Policy.Number
FEES: 'Subdivision Improvement Permit /, lass III '
Public improveme ts:-3%'of'estimated construction costs.
Pr.ivate:.improve ments: 3% of esstimatecl'constr'&ion costs
Minor. Improvement Permit /lass IV: See attached schedule
Inspection Fee $
Permit Fee
'Penalty
Cash Deposit -Surety Bond
if required;
TOTAL: .: $
Receipt No.
Received by Date
Recorded by
NOTE:
i With proper validation
this form constitutes art., ;7
CITY OF LA 'QUINTA
encroachment permit 4
:ter APPLICATION FOR PERMIT '
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water ains
and. other likepublic works improvements in connection with•MINOR IMPROVEMENTS and APPROVED SUBDIV SIGNS
DATE:. March 280 2003
LOCATION OF CONSTRUCTION 80-420 Avenue 52, La
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Offo to water
fire protection
DESCRIPTION OF CONSTRUCTION qe>r lXi �
*ator line'- - 1ST` DIP 313 IF, 18M bo
valve, 1 ea. 8'" vakvetl" detector the
DIMEENSION OF INSTALLL PION 01 REMOVAL
l8 water ttiu It wile Icy' a deep
va
Subdivision Improvement Permit —'C; ss III
Minor Impro1ement.Permit' lass IV
Sketch (attach co str /n, plans if appropr,iate)s. ;.AUTE
ii�
ea, b blow ref 1 ea
SIZE OF EX�AV.ATIQP, IF NEEDED, '' w '%V "xOf 18
c��csP
APPROXIMATE TIME WHEN WORK WILL B. IN .Ap>x 6' ZCr) '
APPROXIMATE TIME OF.COMPL•E`TION' 112AVE,
ESTIMATED CONSTRUCTION COST $ 3�'0'59
(Including removal of all obstruction, �materials, anddebris, baickfilling, com
paction and placing permanent resurfa ing and/or re •lacing irY�provements).
In consideration of .the granting of this permit, the appl.ica hereby agrees to:
'Indemnify,defend-and save the City, its uthorized agents, officers, representative's and -employees, harmless from and against any.and all .
penalties, liabilities or loss.resulting from\claims'or court action and 'ari ing out of any accident, loss or damage to persons or property
happening or occurringya�s,a,,proximate result of any work undertaken. nder the permit granted pursuant.to this application.
Notify•the Administrative -Authority at least twenty-four (24) hours i advance of- the time vJ6en work will be started.
Comply with all applicable City - rrdyinances, the terms and conditio s 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 workv.
Signature of Applicant or'Agent
Price °•a Nuxeery and Garden Supply, In 760-324-1225' '
Name,'of Applicant (please print)
Price's Nuryery & Garden S
Name of Contractor'and Job Foreman
Cont ,qqacto,r r,s License No.
Business Address Telephone No.. .
1 36021 Cez.pbtll,.Cathedral City 92234
Business Address Telephone No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit
Public.improvements: 3% of
Private improvements: 30/0 Of
Minor: Improvement Permit 41
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond .
if required,
TOTAL: $
lass II I
s�
estimatetl construction costs
r stimated construction costs
ass IV: See attached schedule
Receipt No.
Received by Date
Recorded by
PA 3881
PERMIT VALIDATION
PERMIT -NO. .
DATE APPROVED'
.EXPIRATION DATE
DATE: ISSUED
Administrative, Authority
Telephone:.(760) 777-7075
0.
NOTE:
With proper validation ".
this form constitutes an.-,*
encroachment permit
T
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, water11ains
and other like public.works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVyISIONS
DATF- March 28.' 2003
LOCATION OF CONSTRUCTION
Subdivision Impro-v`.ement Permit —
Minor Improvement Permit
80-420 Avonue $2 t La: PC+ Ata
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 0!`fait* uax+ax
fire protection
DESCRIPTION OF CONSTRUCTION install C
grater .dine w its'" DIP 313 LX� IV
Valve Y *a ry" valyab " detector Ch
DIMEd'- wetOrlN,R:= AA�T *1O4a Rby 4
*Men Lik Sketch (attach construction plans if appropriate)
PA SXSEYAPATE
yalve X etas 6`N'blow WWI sa
OwLy tor U
SIZE OF EX.CAVATI.ON, IF NEEDED `s v343 Lor lb-
`�
APPROXIMATE TIME WHEN WORK WILL BEGIN �' '
mVi
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ Of ''�
(Including removal of all obstruction,�materials, andd debris, backfilling, com-
paction and placing permanent resur-4cing and/or replacing improvements)
In consideration of the granting of this permit, the pa pli,�capt hereby agreE
to:
Indemnify, de?end• and save the City, its authorized agents, officers, represrentatives 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 occurrin as a proximate result of any work undertaken nder the permit granted pursuant to this application.
Notify the AdministrativeFAuthority at least twenty-four (24) hours/in advance of the time when work will be started.
Comply with all applicable City <Qrdinances, the terms and conditiorSs 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 workR
Signature of Applicant or Agent
Prices's Nurss►ry and Gar4en Supply, Tn9(. 160--324-1226
Name of Applicant (please print) Business Address Telephone No.
Pric,a's Nursery 6 Gardon Supply, .111 , 36021 Cam+boll, Cathedral. City 92234
Name of Contractor and Job Foreman
Contractorjs License No.
Business Address Telephone No.
City Business License No.
Applicant's Insurance Company / Policy Number
r
FEES: Subdivision Improvement Permit -Class I II
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
f
Minor. Improvement Permit—.P1ass IV: See attached schedule
e
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
.: 888.
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED'
By .
Administrative Authority
Telephone: (760) 777-7075
NOTE:
With proper validation
this form constitutes an', P?
encroachment permit
l
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 SUBDIV4ISIONS
Nioos Subdivision Improvement Permit — jl,ass I
DATE: kl, " Minor Improvement Permit�Class IV
LOCATION OF CONSTRUCTION
CO-470 clvon n 524 Liz fulnta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION t`v,
�:t,yo p8`otc zX
DESCRIPTION -OF CONSTRUC IQ. viacolr
DIM jNSI0 0�F IN TAB L�A,TIION OR RtEMOU
SIZE OF, EXCAVATION, IF NEEDED '
� uc:YJCi1c}ul�. w. r � Sketch (attach c on struc
J 07T 74—ta_ VLX ls/zb
APPROXIMATE TIME WHEN WORK WILL BEGIN t1L�d*
`Y.
APPROXIMATE TIME OF COMPLETION
dykt3i��d
ESTIMATED CONSTRUCTION COST $'
(Including removal of all obstruction,materials, and debris, backfilling, com-
paction and placing permanent resurfac`ing and/or replacing iT'provements)
In consideration of the granting of this permit, the applicant hereby agree
s to:
tion plans if appropriate)
ARA71 L;
Indemnify, defend• and save the City, itsiauthorized agents, officers, representatives and employees, harmless from and against any and all ,
penalties, .liabilities or loss resulting from'iclaims 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.
'1
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;,
g�
Signature of Applicant.or Agent
Name of Applicant (please print) ? Business Address Telephone No.
Name of Contractor and Job Foreman
Business Address
Telephone No.
Contras"tor;,s License No. v F City Business License No.
y
Y
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 v ` a
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No
Received by Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
Recorded by
Telephone: (760) 777-7075