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4464NOTE: With proper validation this form constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FO.R 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 DATE:- August 16, 2005 LOCATIOqqjb�ONSTRUCTION 1 08/08/05 08/21/05 (Street addresQof Description of Locatio - n) PURPOSE OF CONSTRUCTION — DESCRIPTION OF -CONSTRUCTION ivision ment Permit — Class I I I Minor Improve nt Permit Class IV 08- / 08 09 \ 10 11 032 158 DIMENSION OIV4NSTALLATION OR REMOVA, 4 SIZE OF EXCAVATION, IF -NEEDED .0 APPROXIMATE TIME WHEN VbORK WI BEGIN Ly 18 Sketch (attach construction �lans if appropriate) APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION CbST $ (including removal of all obstructio , materials, ;�d debris, back Ming, m- paction and placing permanent r surfacing an re placing impr ve nts) In consideration of the grantin of this permit, the pplicant here agrees to: Indemnify, clefen6 and sav the City, its authorized ag ts, officer representatives employees, harmless from and against any and all penalties, liabilities or loss resulting frW claims or cou t action nd arising ou f any accident, loss or damage to persons or property 0: happening or occurring as proximate result of any wor uncle aken uncle e permit granted pursuant t is apq5a 031 U9 3ion. Notify the Administrative uthority at leJst twenty-four ( 4 ou t&ep9e gjjMtR41-*en work will be started. Comply with all aplp - cable ity Cirdinancesyg'.6494 aRn on'di'tions of the permit and all applicable rules and regulations of the City of La Quinta and to pa�� for a y additional replacement neces ary as the result of this work. Name of Applicant (please pr ivame OT UontraCtor anc! Job t-orVman Contractor's Licens\e�o. Signature of Applicant or Agent Business Address Business Address Telephone No. Telephone No. City Business License No. Applicant's Insurance Co Policy Number FEES: Subdivision ImproVemen er�it — Class I I I _�-a Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor. Improvement Permit — Class IV: See attached schedule N:!.,- 4464' Inspection.Fee $ PERMIT VALIDATION Permit Fee PERMIT NO. Penalty Cash Deposit -Surety Bond DATE APPROVED if required EXPIRATION DATE TOTAL: $ DATE ISSUED Receipt No. By Received by Date Administrative Authority Recorded by Telephone: (760) 777-7075 NOTE: With proper validation this form bWsiitutes 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 DATE: ...,-August 16, 2005 - LOCATIO120 f6%ONSTRUCTION 1 08/08/05 08/21/05 (Street address2or Description of Location) PURPOSE OF CONSTRUCTION — DESCRIPTION OF -CONSTRUCTION DIMENSION OIVINSTALLATION OR REMOVAI MJ I SIZE OF'EXCAVATION, IF —NEEDED 537ITftprovement Permit — Class I I I Minor Improvement Permit Class IV 08— /08 09 \ 10 11 032 158 APPROXIMATE TIME, WHEN WORK WILL/BEGIN APPROXIMATE TIME OF COMPLETION'— ESTIMATED CONSTRUCTION COEST $ (Includinn removal of all obstruction aterials anrl ri-hric KnAjillin 18 Sketch (attach construction klans if appropriate) 'rve 'e4ts) paction and placing permanent re/sur'facing an?ft replacing imp r In consideration of the granting/of this permit, the%\Papplicant here agrees to: Indemnify,.d6fend. and save the City, its authorized agents, officers representatives d employees, harmless from and against any and all penalties, liabilities or loss resulting fro %. �rl T claims or cou 11 action ni ?f any accident, loss or damage to persons or property happening or occurring as a proximate result of any wor uncle aken und e permit granted pursuant t s ap ion. 1 031 pl'55, Notify the Administrative Authority at lealst twenty-four (2�4) ours i —c On n6gae,e qfjgh_*e.'0i-,'e1,%Then work will be started. Comply with all appl' bl ael b ca e C*t 0 dinancesYf.h`e1RteArRW anRZI onclitions of the permit and all applicable rules and regulations of the City of La Quinta and to pa� f 11 y jr or any additional replacement necessary as the result of this work. Name of Applicant (please pr Name of Contract& and Job Foreman Contractor's Licen Signature of Applicant or Agent� Business Address Business Address Telephone No. Telephone No. City Business License No. Applicant's Insurance Company Policy Number FEES: Subdivision I mprovemenl6Per\it — Class I I I mil Public improvements: 3% o estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule 2 4464 Inspection Fee $ PERMIT VALIDATION Permit Fee PERMIT NO. Penalty Cash Deposit -Surety Bond DATE APPROVED if required EXPIRATION DATE TOTAL: DATE ISSUED Receipt No. By — Received by Date Administrative Authority Recorded by Telephone: (760) 777-7075 fio I A, NOTE: With proper validation this form -bon�titutes 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 DATE:'.. August 16. 2005 LOCATION�Qfo CONSTRUCTION 1 08/08/05 08/2-1/05 (Street addresgoi Description of Locatio*n) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION DIMENSION OF'INSTALLATION OR REMOVAL SIZE OF EXCAVATION,_IP1NEEDED 0 APPROXIMATE TIME WHEN WORK W1 /BEGIN I. � — . U LY 1"iZ— n I-M,prevement Permit — Class I I I 1��< Minor Improvement Permit Class IV 08— /08 og \ 10 11 158 Sket ch (attach construction lans if appropriate) APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION C5ST$ (Including removal of all obstructiop�'materials, and debris, backl�lin I g, m- paction and placing :permanent re/ 7 surfa6ing ­anWe, , replacing impreve7ents) In consideration of the granting/of this permit, the applicant her%ey agrees to: Indemnify, d6fend,and save the City, its authorized age ts, officers/representative nd /empi.yees, harmless from and against any and 611 penalties, liabilities or loss resulting froAn claims or cou action rid arising o I any accident, loss or damage to persons or property happening or occurring as a proximate result of any worNt uncle alken under the permit granted pursuant to t s appili5ation. 031 149i Notify the Administrative Authority at least twenty-four (24) houy ign&v.a�e QtgA_e1firnblOw"hen work will be started. '4 b� R afe Comply with all applicable City Ord inancesYffr. fift? ant Vconeditions of the permit and all applicable rules and re ulations of the City of La Quinta and to pay� icir any additional replacement neces!Lry as the result of this work. 9 Name of Applicant (please pr Name of Contractor and Job Foreman Contractor's LicenseN0. Signature of Applicant or Agent — Business Address Business Address Telephone No. Telephone No. City Business License No. I Applicant's Insurance Company Policy Number V FEES: Subdivision Improvement,,Qerryiit — Class I I I Public improvements: 3% o estimated construction costs Private improvements: 3% ci� estimated construction costs Minor. Improverrient Permit — Class IV: See attached schedule 4464 Inspection Fee $ PERMIT VALIDATION Permit Fee PERMIT NO. Penalty Cash Deposit -Surety Bond DATE APPROVED if required EXPIRATION DATE TOTAL: DATE ISSUED Receipt No. By Received by Date Administrative Authority Recorded by Telephone: (760) 777-7075 NbTE: 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 DATE:.,Ausust 16. 2005 LOCATION,;Q,,F F ,)CONSTRUCTION 1 08/08/05 08/21/05 08— (Street addressaor Description of Location) PURPOSE OF CONSTRUCTION — DESCRIPTION OF CONSTRUCTION - DIMENSION OF`j1,jNSTALLATION OR REMOVAL SIZE OF EXCAVATIOP�,IIPNEEDED V . 0 APPROXIMATE TIME WHEN VLORK WILLABEGIN .'56'I'mprovement Permit — Class I I I Minor Improvdment Permit Class IV 08 09 \ .10 11 032 158 \218 Sketch (attach construction blans if appropriate) APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST . $,� (including removal of all obstruction,, materials, and debris, backfilling, com- paction and placing permanent res"U'rfadi—ngandVor replacing improvements) In consideration of the granting' of this permit, the�applicant hereby agrees Ito he*City its authorized agents, off representative, and /e Indemnify, d6fen6 and save,ft moloyees, harmless from and against any and all penalties, liabilities or loss resulting fro I 'R claims or count action j and arising out,of any accident, loss or damage to persons or property happening or occu i k u rr�ing as a proximate result of any work undertaken ncler,.4 permit granted pursuant to this application. 31 140 ve A�Cthority at least twenty-four (24)/hours in,�clvan(�e dfittAdITiAe�1when work will be started. Notify the Administrat i I ft 0 1, Comply with all applica le ity Ord i nancesYffi-e fifts and conditions of the permit and all applicable rules and regulations of the City of La Quinta and to payi ior any additional replacement neces�ary as the result of this work. Name of Applicant (please pri Name of Contract& and Job Contractor's Licen Signature'of Applicant or Agent Business Address Business Address Telephone No. Telephone No. City Business License No. Applicant's Insurance Corn'lpany Policy Number FEES: Subdivision I mprovementNPermjt — Class I I I Public improvements: 3-/��Ofjesti mated 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 V11 4464 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 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, I SubdiVi9i6nn"llffiprovement Permit — Class III Ausust 16, 2005 S DATE: Minor Improvement Permit Class IV LOCATI ON—, _QF,,;%,ONST,,R UCTI ON 08/08/05 08/21105 0&- 08 09 10 11 032 158 \218 (Street address?or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate). \�ket c DESCRIPTION OF -CONSTRUCTION tit DIMENSION OF IINSTALLATION OR REMOVAL ON', - SIZE OF EXCAVATI IF NEEDED 0 APPROXIMATE TIME WHEN WORK WILLABEGIN APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris, backfilling, com- X f paction and placing permanent resurfacl-rg—a—n'a/or replacing improvements) In consideration of the grantin g of this permit, theN:applicant her agrees to: Ile Indemnify, defend. and savetthe City, its authorized agents, off icers/representatives and employees, harmless from and against any and all penalties, liabilities or 16ss resulting frcVp claims or court action Ad arising out�of any accident, loss or damage to persons or property happening or occurring as a proximate result of any work)undert / aken under thle permit granted pursuant to th;is applieer-tion. 'it At Uj 4 140 - - - Notify the Administrative Authority at least twenty-four (24) ours h�acly_an_c�q dfitft& timenoVen work will be started. Comply with all applicable City Ordinances, the terms and-1onditions of the permit and all applicable rules and regulations of the City of I I 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) Business Address Telephone No. Name of Contractor and Job F Contractor's License No. I Business Address Telephone No. City Business License No. Applicant's Insurance Com�any Policy Number FEES: Subdivision I mprovemenf'Permit — Class I I I Public improvements: 3% o stimated 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 4464 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority Recorded by Telephone: (760) 777-7075