3950I
1
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 III
DATE: June 18, 2003 Minor Improvement Permit'Class IV
LOCATION OF CONSTRUCTION East side of Washington Street and Fred Waring
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION System improvements Sketch (attach construction plans if appropriate).
DESCRIPTION OF CONSTRUCTION EYcayation & .installation
of underground conduit. Install (1) power pole.'-- *See Attached Special Conditions*
DIMENSION OF INSTALLATION OR REMOVAL (1) power pole,
18' trenching and conduit installation
SIZE OF EXCAVATION, IF NEEDED 4' x 185' x 4'
'APPROXIMATE TIME WHEN WORK. WI.LL-BEG(IN Upon r e'p
APPROXIMATE TIME OF COMPLETION 15. ays
ESTIMATED CONSTRUCTION COST $ 95 00
(Including removal of all obstruction, materials, a d debris,7iv
ing, com-
paction and placing permanent resurfacing and/o replacinements)
In consideration of the granting of this permit, t e applicby agrees t
Indemnify,.de?end and save the City, its authorize agents, representatives and employees, ess from and against any and all
penalties, liabilities or loss resulting from claims o court ad arising out o any ac t, loss or damage to persons or property
happening or occurring as a proximate result of any work un under the p rmit granted pursuant to this application.
Notify the Administrati Authorityat least twenty-f ur (2i advance of he time when work will be started.
Comply with all applicable y Ordinances, the terms nd s o e per it and all applicable rules and regulations of the City of
La Quinta and to pay for any ditional replacement n cessary as the result of this work.
Signature of Applicant or Agent
D. P.O. 0,937, e is CA 92251 60 33 — 238
Name of Applicant (please print) 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
N2 3950
PERMIT VALIDATION
PERMIT NO. 3950
DATE APPROVED July 23, 2003
EXPIRATION DATE July 31, 2004
DATE ISSUED
By,
Administrative Authority
Recorded by Telephone: (760) 777-7075
c
.NOTE:
With''proper validation' O�
�r- this form cons'
`encroachment permit
CITY. OF `L•A QUINTA',
APPLICATION. FOR. PERMIT,
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)c.
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
F_
Subdivision Improvement Permit - Class.
-DATE: ' Jane "18' 2003.' Mlnorlmprovement Permit Class IV
LOCATION,OF CONSTRUCTION East side of Washington Street -and -Fred -Waring
(Street addressor Description of Location)`
PURPOSE OF'CONSTRUCTION SYdtem imyrovements Sketch (attach:construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 19xCavatimn '& installation "
of Uhde ound .conduit'. install. {1)-yower pole *See' Attached.'Special Conditiozis*
' - recoitductbrink (4) 397.5 -MCM AAG on eXistin;a ool:es
DIMENSTON.OF INSTALLATION OR REMOVAL (1) •power pole.
r1$' trenchinla: anit conduit 'installation
" SIZE OF EXCAVATION, IF NEEDED. '4� 185,1 x 4' ) '
APPROXIMATE TIME WHEN WORK WILL.BEGIN U1002 -Q A t
* 1 'A£ n�xana�lC :• ; Y
APPROXIMATE TIME 'OF COMPLETION 15 4aVa .. r
E'STIMATED CONSTRUCTION COST $ 95.000 1
:''(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, 'appli'cant hereby agrees.to: ;
Indemnify, defend, and save the City, its authorized agents, officers, representatives a employees, .armless from and against any and all .
penalties; liabilities 'orioss'resulting 'from claims'o� court action and arising'out of any aceident,.loss or damage to persons or property..
happening or occurring as, a.,proximate result of any`
work underta4n under the permit granted pursuant to this application.
+ "Niotify, tFie Administrative -Authority at least twenty-four (24)' hours ih advance of he time vJh'en work will be started.
� ` � /fit
Comply with all applica,Iee i,t\y Ordinances, the termsl`nd conditions of t a perm'it and all applicable rules and regulations of the Clty of
La, Quinta and to .pay for any 8dditional replacement ,necessary as the result of this work. '
. T Signature of Applicant or' Agent
P. 0 937.. Im)erial. CA 92251 060) 339�9238 `'
Name of'Applicant (p'lease print) 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'lmprovement 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 ' �; 95(�
1 Inspection'Fee $ PERMIT VALIDATION
Permit Fee PERMIT'N0. 3950
Penalty July 23, 2003
Cash Deposit -Surety Bond DATE APPROVED
if required' EXPIRATION DATE July 31, 2004
-TOTAL: $ DATE ISSUED
Receipt No. .
:.•µ • gy
Received by Date Administrative Authority
Recorded by Telephone: (760) 777-7075
NOTE.-
Wiih proper validation
this form constitutes an.
encroacliment'permit' CITY OF LA QUINTA ti
APPLICATION FOR-' PERMIT;
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) ''•�� " w4�
OF TH$�
• for the. construction of public or private .curbs,, driveways, pavements, sidewalks; parking lots, sewers, water mains a
and other like public works improvements in connection with MINOR IMPROVEMENTS and'APPROVED SUBDIVISIONS '
Subdivision Improvement'Permit.— Class III
DATE: I$• 1003 Minor lmprove'ment Permit Class IV
LOCATION OF CONSTRUCTION('', Ust side of 'Waehitueton Street••and Pred•'Warinst �.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach, construction plans if appropriate)
.DESCRIPTION OF CONSTRUCTION Iacca'aatidn & i><vet+alieition „r'' ,
of 4 iderli4round e6aduit., Inat all (1) nower pole* *ff e'.Atteched,'Speciml Condi. ;LonO.:
•recomdudtdiriull .(4 l.97:5 MCM AAG-`ini'.iexintinsx o6lea
DIMENSION OF -INSTALLATION OR REMOVAL' Cif •;)MOk ooAo;' ,
F1 ' trenchirm and conduit inatetuatiou ' t
SIZE OF EXCAVATION; IF`NEEDED 4' x 1851 x• 4' :
` APP,ROXIMATE TIME WHEN WORK WILL BEGIN•Doa
Of iink-mit,
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION'COST $ 95*000
(Including removal of all'obstruction,.ma.terials, and debris, backfil.lirig, com ,k
pactiori and placing permanent' resurfacing and/ory replacing improvements),. _ I
In consideration of •the:granting Hof' this. permit,•the applicantihereby agrees to:
Indemnify;,defend.-and save the City, its authorized agents, officers, representatim,and employees, harm ess from and against any 'and all
?' penalties; liabilities or loss'.' resulting, from claims or court action and arn"t loss out any'accidess 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°•t a 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.Applicanf or Agent
B0 937'� _ sie iel` CA 92251 (760)' 339-�3 3g
Name of Applicarit (please print), Business Address Telephone No.
Name of Contractor and Job Foreman, Busiress 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 i >
Public.improvements: 3% of'estimated construction costs 4
Private improvements: 3%.of estimated construction costs.
Minor. Improvement Permit'- Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
Permit Fee PERMIT N0. 3950
Penalty r 4
Cash Deposit -Surety Bond
DATE'APPROVED' JiAY.23� 2003
if required S y.'3 004
„ EXPIRATION DATE JLtI 1 Z
TOTAL•:.' $" DATE ISSUED
Receipt No. ,..
BY.
Received by Date Administrative Authority
Recorded by ' Telephone: (760) 777-7075
NOTE:
. Wlth"proper validation, '
�.
•... ahis form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION. (ENCROACHMENT)„
I.fmv.+o 4+
f ' !
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class I I I
DATE: Jan* I•$. 2003 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION $ASt > idd of Vavh asttroa Stre at and Faced Waring
(Street addressor Description of Location)
PURPOSE OF CONSTRUCTION Sy'dtam ItIR OYMO Ito Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
rah
a atoaftatorlan (4) 397.5 2lCt AAG. on exiotiuA Voi,aa
DIMENSION OF INSTALLATION OR REMOVAL 0) 202CE 0011 *
SIZE OF EXCAVATION, IF NEEDED ' � X 185i x 41
APPROXIMATE TIME WHEN WORK WILL BEGIN 100n K*Cdift,
A1% .AAN'llt.i }�
*See Attcactlad $V60141- Conditioaoe
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 95.6000
(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 authorizedagents, officers, representatives and employees, harmless from and against any and all
.penalties; liabilities or.•Ioss 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,vyork 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,perrnit and all applicable rules and regulations of the City of
r
• La Quints and to pay for any additional replacement necessary as the result of this work.
Signature -of Applicant or Agent .
() 3 38
Name of Applicant (please print) 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: SubdivisionImprovement 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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT NO. 3930
DATE APPROVED Jul? 23, 2003
EXPIRATION DATE July 31$ 2004
DATE ISSUED
By
Administrative Authority
Telephone:.(760) 777-7075
NOTE:
Witli?proper validation; , ' •
',
. {
'
athis
f
u+`4
'
llvform constitutesan .
'encroachment permit
CITY OF LA QUINTA
k-°''
APPLICATION FOR -PERMIT'; ,•.•
,•
PUBLIC
WORKS CONSTRUCTION (ENCROACHMENT).
For the, 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 I I
DATE:' �� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION V489 Oidt of U811hir-stoU Str4st And Fred' Volga
(Streef'address'or Description of Location)
PURPOSE OF CONSTRUCTIONSketch (attach construction plans if appropriate)
'DESCRIPTION OF -CONSTRUCTION ••
of uh4ro mud conduit. Install (1) po r 'Palo.. Attwlhed'Sg;ocial Golaiill l6nn*
z 6t*n lu;:tz3rftn.,A4) 397.5 MCi. AAC Ott oXia 'ring Stm
DIMENSION OF INSTALLATION OR REMOVAL (1) -powor volts
10'
' SIZE OF.,EXCAVATION, IF NEEDED R T y,' • ''
APPROXIMATE TIME WHEN WORK WILL BEGIN
• "' APPROXIMATE TIME OF COMPLETION
. ESTIMATED.CONSTRUCTION COST $
Oncluding 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:
a, �' ` • 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 ocourt 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. I'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,
a" -,La buinta and to pay'for any additional replacement necessary as the result`ofithis work.
ttf) +
:1 ,k Signature of Applicant or Agent
k 11Pe'0k. Boo 937s, TUL Paxiial CA 02251 -766) 337.:92.3$ .r
l t Name of Applicant (please print) Business Address Telephone No. ;
Name of Contractor and Job Foreman ' Business Address Telephone No.
Contractor's License No. City Business License No. r
�..
-Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class l l l -
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 VALIDATION
Permit Fee 395t1
PERMIT NO.
Penalty July, 230 20,03
Cash Deposit -Surety_ Bond DATE•APPROVED
July 3i C
if required
_ EXPIRATION DATE '
TOTAL: $ '
DATE'ISSUED
Receipt No.
,. By
Received by "` Date .•a. Administrative Authority
Recorded by _ Telephone: (760) 777-7075
M
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