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4249r tz c ; •With:propervaltlation �� --.this form co,nsfitutes`an encroachment permit, CITY' OF LA QUINTA APPLICATION. FOR .PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT). ei C� OFTf��wS y: For�6e. 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 K DATE: �0/4,' 04 ' Minor Improvement Permit Class IV • LOCATION,OF CONSTRUCTION SW Corner of Ave. 52 b M nroe 'St. TH 31202 ti(Street addressor Description of. Location) . PURPOSE•OF,CONSTRUCTION YnEtall swer Force M81n Sketch (attach construction plans if appropriate) R per .C%M Plans 1 DESCRIPTION OF CONSTRUCTION g . DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APP,.ROXIMATE TIME WHEN WORISIWILLBEGIN' • ' 'APPROXIMATE TIME OF COMPLETION. ESTIMATED CONSTR`U.CTION COST $ s ti (Including -removal of all obstruction materials, and debris, backfilling, com- paction and'.placing permanent resur,acing and/or replacing improvements). In `consideration of the granting of this permit, the applicant hereby agrees to: Indemnify, defend' and. save the City, its authorize/d agents, officers, representatives and employees, harmless from and against any and all penala lties, .liabilities o' loss resulting from 'claims court action and arising out of any accident, loss or damage to persons or property 111111 // happening or occurring as a proxima a result of ny work undertaken under the peerrr' it granted pursuant to this application. t.9 i Notify 4the Administrative Authority a least t enty-four (24) hours in advance f the time when work will be started. Comply with all applicable City Ordinances, terms and conditions of the permit and all applicable rules and regulations of the City 'of k. La Quinta and to pay tfor any additional replacement necessary as the result of this work. + •• f Name of Applicant (please print) Name of. Contractor and Job Foreman Contractor's License No. • a Signature of Applicant or Agent r Business Address Business Address Telephone No. Telephone No. City Business License No. Applicant's Insurance Company Policy Number r. FEES: Subdivision.lmprovement Permit — Class;l 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 4249 PERMIT VALIDATION PERMIT NO. DATE APPROVED ` EXPIRATION DATE DATE ISSUED By Administrative Authority *r Telephone, (760) 777-7075 1 c NOTE: - Y With proper validation , Q' this form constitutes an 'CITY- OF LA QUINTA encroachment permit ' APPLICATION FOR. PERMIT J 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 _ Subdivlslon'lmprovement Permit'— Class III DATE: ' 10/-4/04 ,Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION ' SW Corner o Ave. '52 -& Monroe' St.. .TM 31202 (Street address or Description of Location) t PURPOSE OF CONSTRUCTION Irstclil sewer force _Main .Sketch (attach construction plans if appropriate) per . CVWlj, Pi1-.:ns DESCRIPTION OFCONSTRUCTION• ' T 65' Crossiz: 14oni---oe into . Riverside C6unt�7 ` .'DIMENSION OF.INSTALLATION OR REMOVAL{ SIZE OF EXCAVATION, IF NEEDED ' APPROXIMATE TIME WHEN WOR i I L BEGIN. APPROXIMATE TIME OF COMPLE ION ESTIMATED CONSTR CTION COS $ ' (Including removal 'of a I obstruction materials, and ebris, backfilling, co' pactioh and placing pe manent resur acing and/or r placing improvements) In co ideration of :the granting of • is permit, th applicant hereby. agrees to: -In mnify, defend• a d save the Cit its' authoriz d'agents,. officers; representatives and emp gees, harmless from and against any and all pena ties, liabilities o loss.resulting'from claims or court action and arising out of any ccident, loss or damage to persons or property happe ing or occurrin as a Proxima a result of any -work undertaken under the per t granted pursuant to .this application. Y Notify the Administra ive Authority a least enty-four (24) hours in advance the time when work will be started.- ' Comply with all applicable City Ordinances, the •terms and conditions.of th permit and all applicable rules and regulations of the City of La Qu1nta and to pay' for -any additional replacement necessary as the r It of this work. -Signature of.;Applicant or Agent .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. e Applicant's' Insurance Comp ny Policy Number FEES: "Subdivisio mprovement Permitt•— Class III Public improvements. 3% of estimated construction costs Private improvements: 3% of estimated construction costs , Minor Improvement Permit —Class IV: See attached schedule 4249 `� '. -Inspection Fee y $ ^' PERMIT -VALIDATION - Permit Fee PERMIT NO. L Penalty ,Cash Deposit -Surety Bond - DATE APPROVED if required EXPIRATION DATE ' TOTAL: $� r Receipt No. _ +.. DATE ISSUED By — .Received by Date ,,Administrative Authority ' Recorded by Telephone: (760) 77777075 NOTE: 3 'With proper.yalidation ` :this form:consfitutes'an CITY OF LA QUINTA encroachment permit ti� g+ APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)" s For • the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and o er'like public .works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS 4. a Subdivision Improvement Perpit .� Class I I I DATE: 104ti 4"\Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION SW Corner of Ave. 52 & MBnroe St.. TM 31202 (Street address or Description of Location) PURPOSE OF CONSTRUCTION Install swwr Force Main Per .-CVWD Plans DESCRIPTION OF -CONSTRUCTION %ri'� ,(�vn�o•P r.n Mnrrnn ter.}ice Die.e... e•. •i .i .. l......}.. DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APP,.ROXIMATE TIME WHEN WORK&ILL BEGIN Sketch (attach construction plans if appropriate) APPROXIMATE TIME OF COMPLETION y, 4 t';ESTIMATED CONSTRUCTION COST $ (I'ncluding,removal of all obstructioni materials, and debris, backfilling, com- g.I. • •-paction and placing permanent resurfacing an replacing improvements) lh_. nsideration of. the (granting of this permit, the applicant- hereby agrees to: Indemnify, defend, and save the Cit' its authorized agents, officers, representatives and emp.•yees, harmless from and against any and all IF. penalties, liabilities o` loss resulting from claims or court action and arising out of any ccident, loss or damage to persons or property �\ g g p y per it granted pursuant to this application. happening or occurring as a roxima a result of n work undertaken under the /� Notify i e Administra}ive Authority of least enty-four (24) hours in advance aY the time when work will be started. ; Comply with all applicable City Ordinances, the terms and conditions of the, -Kermit and all applicable rules and regulations of the City of , t La Quinta and to pay or any additional replacement necessary as the r stilt of this work. Signature of Applicant or Agent Name of Applicant (please print) el Business Address Telephone No. xF` Name of -Contractor and Job Foreman Business Address Telephone No. \ Contractor's License No. City Business License No. Applicant's Insurance"Co jany Policy Number FEES: Subdivision,lfnprovement'Permit — Class 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 Fe'e Penalty ,Cash Deposit -Surety Boh,,d if required TOTAL: $' •:.i.;ll.>.' Receipt No. Received by Date Recorded by N 4249 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority Telephone.: (760) 777-7075 k With proper .validation y: this form constitutes an CITY OF ' LA QUINTA encroachment permit APPLICATION. FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For,i,the construction of public or private curbs, driveways, pavements, sidewalks, 'parking lots, sewers, water mains and otlier, 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 SW Corner of Ave. 1 & Mnrod St. TM 33.2D.2 F (Street address or"Description of Location) PURPOSE -OF CONSTRUCTION Install Ster Forces ftin Sketch (attach construction plans if appropriate) per OWD Funs 1 DESCRIPTION OFCONSTRUCTION�`� " 6S -.Cr©stris9 ?ortianta Riv�xmida Cua��g DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED ` r APPROXIMATE TIME WHEN WORIIWILL� BEGIN qp APPROXIMATE TIME�OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstr•uctionii materials, and debris, backfilling, com- 1 paction. and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit, the applicant hereby agrees to: f •wti h i• F Indemnify,. defend, and save the City, its authorize### * 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 an�accident, loss or damage to persons or property happening or occurring as a proximate result off --any work undertaken under the permit granted pursuant to this application. Notify the Administrative Authority at, t twenty-four (24) hours in advance of' he time when work will be started. Comply with all applicable City Ordinances, the terms and conditions of the/permit /permit and all applicablerules 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 Name of Applicant (please print) Name of Contractor and Job Foreman Contractor's License No. Applicant's Insurance Cc Business Address' Telephone No. Business Address Telephone No. City Business License No. r. f 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 Inspection Fee $ Permit Fee Penalty d Cash Deposit -Surety Bond if required TOTAL`. $ Receipt No. Received by Date. Recorded by Policy Number ' 4249 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED ,t... r By. Administrative Authority Telephone: (760) 777-7075 �y r,- f- ,IlUiah proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For v-the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and -othe�'Iike public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS I f r 10/4/04 Subdivision Improvement Permit —Class II I DATE: Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION W Corner of Ave..'5� & Xfrie St TM 3i202 (Street address or Description of Location) PURPOSE OF'CONSTRUCTION 1"t all SWUNK FOX" HAIU Sketch (attach construction plans if appropriate) i. DESCRIPTION OF CONSTRUCTION � DIMENSION OF INSTALLATION OR REMOVAL a SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORKtWILL.BEGIN APPROXIMATE TIMEF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) t i In consideration of the wanting of this permit, the applicant hereby agrees to: • s 1 V Indemnify, defend, and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resultingtfrom claimssor court action and arising out of anaccident, 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. t +Notify the Administrative Authority atQeast wenty-four (24) hours in advance of the time when work will be started. t Comply with all applicable City Ordinances, the terms and conditions of theyp rme it and all applicable rules and regulations of the City of La4Quinta and to pay for any additional replacement necessary as the result of this work. / Signature of Applicant or Agent Name of Applicant (please print) Name of Contractor and Job Foreman Contractor's License No. Applicant's Insurance Company Business Address Telephone No. t Business Address Telephone No. FEES:.- Subdivision Improvement Permit — Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs V 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 City Business License No. Policy Number ,.4 449' PERMIT VALIDATION i PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority Telephone: (760) 777-7075 ..h