4521NOTE:
With proper validatitn
this form cgnstitutes 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
y- and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class I I I
DATE: October 13, 2005 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 77-345 Calle Sonora; SW Corner of Calle Sonora & Rubio
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Recnntnoot aewpr nftp-r rP-
10cat•fon
DESCRIPTION OF -CONSTRUCTION Px P,%rgtP hole & trprrh
and bar•kfill
DIMENSION OF INSTALLATION OR REMOVAL -6' — 7' jig a - hnl a;
+ 6' of trPneh- + 6 Apnth
SIZE OF EXCAVATION, IF NEEDED �kv rau
APPROXIMATE TIME WHEN WORK WILL BEGIN
rlernhor +5_ 900 -
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION November 15. 2005
ESTIMATED CONSTRUCTION COST $ 700.00
(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 authorized 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 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.
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!
Name of Applicant (please print)
Signafurejof Applicant or Agent
Business Address
Telephone No.
Pink, Inc. P.O. Box 1012 Palm Desert, CA 92261 340-0988
Name of Contractor and Job Foreman Business Address Telephone No.
CA 693492
Contractor's License No.
4807
City Business License No.
American Safety Group ' 10GSP00055
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ NA
Permit Fee 100.00 "
Penalty
Cash Deposit -Surety Bond
if required "
TOTAL: $ 100.00 '
Receipt No.
Received by Date
Recorded by
s4 4521
PERMIT VALIDATION
PERMIT NO. 4521
DATE APPROVED 4 AO S
EXPIRATION DATE ( o/l 4A> G
DATE ISSUED t>/(
r "
By
Administrative Authority
Telephone: (760) 777-7075
3
�2
_.'NOTE;. !.• .:
With proper . jd tlon j
this form con11 stitutes an CITY OF LA QUINTA
ake_ncroachment 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
DATE: October 13, 2005
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
77-345 Calle Sonora; SW Corner of Calle Sonora & Rubio
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Reconnect sewer after ire —
location
DESCRIPTION OF -CONSTRUCTION exctsvata bole & trench
and backfia.l
DIMENSION OF INSTALLATION OR REMOVAL 6' — 71 dia. hole
6' of trench. ; 6 dAnth
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME WHEN WORK WILL BEGIN October ±5. 2005- Lrlu
D
APPROXIMATE TIME OF COMPLETION November 15. 2005 nrT • 17 2005
ESTIMATED CONSTRUCTION COST $ 700.00
' (Including removal of all obstruction, materials, and debris, backfilling, com- CITYOFLAQUINTA
action and placing
p p g permanent resurfacing and/or replacing improvements) FINANCE DEPT.
In consideration of the granting of this permit, the applicant hereby agrees to:
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 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.
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!
�*f
or Agent
H..Spencer Kniaht 77345 Calle Sonora La Ouinta.'CA 192259 880-3650
Name of Applicant (please print) Business Address Telephone No.
Pink, Inc. P.O.-Box 1012 Palm Desert, CA 92261 340-0988
Name of Contractor and Job Foreman Business Address Telephone No.
CA 693492 4807
Contractor's License No. City Business License No.
American Safety Group IOGSP00055
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor. Improvement Permit — Class IV: See attached schedule
Inspection Fee $ NA 11
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
100.00
100.00
- Received by Date
PERMIT NO
El
i
4521
PERMIT VALIDATION
4521
DATE APPROVED
EXPIRATION DATE 1 t'/1 4%
DATE ISSUED. ( C-/) 4A-> 5
By
Administrative Authority
Recorded by 11 Telephone: (760) 777-7075