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4312NOTE: . With proper validation this form constitutes an encroachment permit ?h^']'�'i.:'.�F'•'�'n"i:�?F ]SR 6•.Y"J,6i�i,F" ftN 1 .yt. i„ . ;. 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:11—i-2004 Minor Improvement Permit Class IV HIGHWAY 111 AND WASHINGTON �/'NIGHT WORK LOCATION OF CONSTRUCTION .(Street address or Description o Location) CLEA ER LIiVES p appropriate) Pl1 POSE OF CONSTRUC ON Sketch (attach cons tion tans if a DES IPTION OF CONSTR CTION ,7AN S WAGE LINES. " DIMEN ION OF INSTALLAT ON OR R MOVAL SIZE OF XCAVATION, IF_N EDED APPROXI TE TIME WHEN. ORK ILL BEGIN APPROXIM TE TIME OF COM LETI N 11-2-200 ESTIMATED ONSTRUCTION OST (Including rem val of all obstru tion, r iaterials,,and debris, backf llin com- paction and pl cing permanent esurf ing and/or. replacing imp ove ents) Inf consideration of the grantin of thUen24 , the applicant h reby agrees to: Indemnify,. fend: and ?save he Cityorized agents, office repr sentatives and a ployees,'harmless from an against any and all penalties,. lia 'lities or, loss. suitingims or.court action nd ari �ng out of any a cident, boss or damage pertsons or property,. happening or ccurring as a roximaof any work undert en un er the perm it.gr nted pursuant to this plication. Notify the Ad inistrative thority wenty-four 1241 ho rs in ad ante of the tim when work' will be tar4ed. Comply with al applicable ity Ordihe terms and condi ions of a permit and all pplicable rules a regulations of the City of La Quinta and t ,pay for ny additicement necessary s the res It of this work.Signat re of Applica r Agent CVTArD /Llo �i a 'erPa DeserL, CA 832-2698 Name of Applicant (please print) Business Address e a No. CVWD/ Pa1ri,Desert, CA 832.-26.9 Name of Contractor and Job Foreman Business Address T e No. NOT APPLICABLE NOT AZ'PLiCABLE 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 $ Not A12121-i ca1i1 e PERMIT VALIDATION Permit Fee PERMIT NO. 4119 Penalty 11-02-2004 Cash Deposit -Surety Bond DATE APPROVED if required EXPIRATION DATE 11-02-2004 TOTAL: $ d �J' "" ^ DATE ISSUED y Receipt No. ' `By Received by Date Administrative Authority Recorded by Telephone: (760) 777-7075 ' :With proper validation ` this -,form constitutes an eneroachment 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:11-1-2004 Minor Improvement Permif bass IVY LOCATION OF CONSTRUCTION HIGHWAY 111 AND WASHINGTON / NIGHT WORK w (Street address oe Description of Location) PURE POSE OF CONSTRUC-RION CLEAN\\"SLR LINES DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED ! N APPROXIMATE TIME WHEN WORK WILL BEGIN Sketch (attach AGE LINES 11-L-GVV4 APPROXIMAtTE TIME OF COMPLET100 N ESTIMATED, CONSTRUCTION COST -- i (Including removal of all obstruction, materials, and debris, backfilling� com- paction and placing permanent resurfacing and/or replacing imp `ovements) In cons ideratio n\of the granting of this permit, the applicant heirebyagrees to: Indemnify, dfend,and save the;City, its authorized agents, officer, representatives and eml penalties, liabilities or loss r�sulting from claims or court action and arisking out of any a5 happening or occurring as a proximate' result of any work undertaken under the permit grr Notify the Ad, inistrative AC thority A` least twenty-four (24) hou''lrs in advance of the time Comply with, all applicable City Ordind\ ces, the terms and conditions of t111he permit and all La Quinta and to pay for any additionllal replacement necessary as the result of this work. ion plans if appropriate) loyees, harmless from ident, loss or damage ited pursuant to this when work will be sil against any and all persons or property ication. applicable rules an regulations of the City of { Signatbre of Applican$or Agent CVWD /Lloyd alley Pa Desert, CA 832-2698 Name of Applicant (please print) Business Address Telephone No. CVWD/ Palm Desert, CA 832-2698 Name of. Contractor and Job Foreman Business Address NOT APPLICABLE Contractor's License No. Telephone No. ., ICABLE 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 4312 Inspection Fee $ Not Annlieable PERMIT VALIDATION 4.3Y 1 Permit Fee PERMIT NO. /A11 9 Penalty 11-02-2004 Cash Deposit -Surety Bond DATE APPROVED if required EXPIRATION DATE 11-02-2004 TOTAL: $ 12927DATE ISSUED Receipt No. 1 By Received by Date Administrative Authority Recorded by Telephone: (760) 777-7075 •"NO.TE: 'With p'r'oper validation this form, constitutes an encroachment permit \y r A..'CITY,•.OF LA QU,INTA.- 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:11-1-2004 Minor Improvement Permit"Class IV,, HIG$EsTAY 111 AND WASHINGTO14 / NIGHT WORK , LOCATION OF CONSTRUCTION (Street address or Description of Location) Ci.EA WER LINES ,\ . PURPOSE OF CONSTRUCTION , Sketch (attach consiYution plans if appropriate) DESCRIPTION OF CONSTR� CTION yj' UUV1 �tNUG& q ! L GLh" S1W;GE LINES' DIMENSION OF INSTALLATION OR REMOVAL 19744 t SIZE.OF , XCAVATION, IF NEEDED J APPROXI ATE TIME WHEN WORK ALL BEGINA. 1l-GAL APPROXIMATE TIME•OF COMPLETION —1—ZU ESTIMATED CONSTRUCTION COST ) (I,ncluding removal of all obstruction, materials, and debris, backfilli paction and placing permanent fesurfafing and/or replacing impro\ In consideration of the granting, of th's permit, the applicant here F 1 Indemnify,.defend•and save the City ,'its authorized agents, officers, penalties, liabilities or loss resulting fr om claims or court action ant happening or ccurring as a claims or court action anttproximate result of any work undertake s Notify the Adinistrative Authority A least twenty-four (24) houllrs Comply with all applicable City ordinances, the terms and condition La .ouinta and t pay for any addition replacement' necessary as .tt 3 F. . com- ,enjents) bY a rees to: repr9sentatives and a ployees, harmless from an. against any and all i arisying out of any accident, loss or damage T persons or property n under the permit granted pursuant to this plication. in advance of the time when work will be started. s of he permit and all pplicable rules a regulations of the City of e res It of this work. 4 � • Signature of Applicant4,or Agent C(?`0 /Lloyd of ley $a Dee_ er&;A CA - , 832-2698 Name -of Applicant (please print) Business Address. Telephone No. CVWD/ Palm Deeest, CA '832-2698, Name of, Contractor and Job Foreman {.cr, Business Address MTelephone No.' ' NOT APPLICABLE.'; .. NOTAPPLICABLE.' Contractor's License No. City Business License No. `F Applicarit's Insurance'Company Policy Number FEES: Subdivision Improvement Permit — Class I I I Public improvements: 3% of estimated construction costs I Private improvements: 3% of estimated construction costs Minor.. Improvement Permit — Class IV: See attached schedule g 4312.:� Inspection Fee .. $ Not Aoolicable PERMIT VALIDATION Permit Fee PERMIT NO. 4312. Penalty 11-02-2004 Cash Deposit -Surety Bond DATE APPROVED if required EXPIRATION DATE 11-02-2004 TOTAL: $ DATE ISSUED Receipt No. BY Received by Date Administrative Authority Recorded by _ Telephone: (760) 777-7075 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 connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement Permit — Class II I DATE:11'1`°�404 Minor Improvement Permit Class IV. HIGHWAY 111 AND WASHINGTON / NICHT WORK LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCT}ION. DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL LINES SIZE OF EXCAVATION,.IF NEEDED 'z APPROXIMATE TIME WHEN WORK WILL BEGIN Sketch (attach constructiplans if appropriate) FOR LINES APPROXIMATE TIME OF COMPLETION si-�c«-svv�s ESTIMATE AONST R UCTI ON'COST. (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfalcing and/or replacing improvements) In consideration\of. the granting of this permit, the applicant hereby agrees to: Indemnify, defend• and save penalties, liab ities or loss happening or occurring as a Notify the Administrative P Comply with allapplicable La Quinta and to pay for a he CityI its authorized agents, officer, repr !sulting from claims or court action and ari )roximate result of any work undertaken ur i thority at least twenty-four (24) houtrs in a ity Ordinances, the terms and conditions of y additional replacement necessary as the re itatives and employees, harmless from and against any and all I out of any accident, loss or damage to persons or property the permit granted pursuant to this application. nce of the time when work will bestarted. permit and all .applicable rules and regulations of the City of I t of this work. . "° Signature of Applicadf crr Agent CVWP /L oyd la, lay Pala basert, CA ,� � 832-2698 Name of Applicant (please print) r Business Address Telephone No. Cvi�/ Palm Death, CA €332-2698 Name of Contractor and Job. Foreman Business Address Telephone No. NOT APPLICABLE NOT A# PLiCABI:8 Contractor's License No. City Business License No. Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit— Class II 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 $ Not Applicahle Permit Fee Penalty Cash Deposit -Surety Bond if required t f TOTAL: $ Receipt No. Received by Date 4312 PERM,1T•y.ALIDATION "YWrY PERMIT NO. 4312 11-0 -2004 DATE APPROVED EXPIRATION DATE 11-02-2.004 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 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: Minor Improvement Permit Class IV, LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION C-.,I;A t WWER LINES DESCRIPTION OF CONSTRUCTION t DIMENSION OF INSTALLATION OR REMOVAL 1 SIZE OF EXCAVATION, IF NEEDED IV I i"I t 3 1 APPROXIMATE TIME WHEN WORK WILL BEGIN Sketch (attach construction plans if appropriate) StWAGH LINES APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris, backfillingt; com- paction and placing permanent fesurfab ing and/or replacing improvements) t In considerationof the granting of this permit, the applicant hereby agrees to: Indemnify,. defend and save the City its authorized agents, officers, representatives and el penalties, liabtiities or loss resulting from claims or court action and arising out of any ac happening or occurring as a proximate result of any work undertaken under the permit gra Notify the Alnistrative Authority ai least twenty-four (24) hours in advance of the time Comply with all applicable City Ordinances, the terms and conditions of the permit and all La Quinta and t'. pay for any additional replacement necessary as the result of this work. 3 � f �t� {F. Signature of Applicar CVWD /L1oyy T�i1.oy Pas.ilw'Daaert. CA Name of Applicant (please print) CVi D1 aes, harmless from and'against any and all nt, loss or damage to persons or property I pursuant to this application. en work will be started. I licable rules and` regulations of the City of ent 832-2698 Business Address ,� Telephone No. Palo Deegrt; CA 832-2 i98 Name of Contractor and Job Foreman Business Address Telephone No. NOT APPLICABLE NOT APPLICABLE - 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 sr InsInspection Fee riot Applicable P $ �� PERMIT VALIDATION Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: $ Receipt No. Received by Date Recorded by PERMIT NO. 4312 DATE APPROVED 11-02-2004 EXPIRATION DATE DATE ISSUED By Administrative Authority Telephone: (760) 777-7075 ;c :OF TS�9 Date: Al" APPLICATION FOR PERMIT Location of Construction: % 0s(^.;1 Purpose of Construction: 4'4e4el S�=�°a�cas�. 1.� , ;�► Description of Construction: )¢G.-d &- T& & ek Dimension of Installation or Removal: Approximate Construction Start Date: — 61 /V 4 : CUD a Approximate Construction Completion Date: 6.00 W-A . Estimated Construction Cost: $ J�1. (r Fstimated Construction Cost shall include. the removal of all obstructions, materials, and debris, back -filling, compaction and placing permanent resiufacing and or replacing improvements Name of Contractor: e 6 e - kvi p Contractor Address:. Contractor Telephone Number: 3 Contractor State License Number: Contractor City Business License Number: ► A COPY'OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED -4 Applicant or Contractor General Liability Insurance Company: Applicant.or Contractor General Liability Insurance Policy Number: Office Use Only: Inspection Fee: . Permit Fee: As -Built Deposit: Dust Control Deposit: Credit Amount: t TOTALTE.E DUE: Ivb Office Use Only: Assigned Permit Number. C{ ApprovalDate��Z�v��1 Expiration 1 t /O Zi /b4 Date: ``'� ,, Issue . Date: Administrative Authority- E 1 �• �AR, V•N -c+ v� '• .c � fi - f r - q 44 Short -Term`, ..e r `.i Al e�' y J s (-f 2 4 1 - ; . | � �` ƒ /� � | ƒ � a _ | { � � | } � | ij I . � `` ) ilk \% si . :2 D \ -% GQ� ` / �� . . , . - | - | ' . { � . \.\\. \� �\\��/��`