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o.:—� `r"h-' :�-._•� - ..—��_.� �:—.�—►.--��.--..—tom:�_ �� _•o� � ,e�Y��'.' ,.� �_�-'�_A"�"��"
NOTE: -
With proper validation 2•
this form constitAT an
CITY OF. LA QUINTA
. encroachmen� permit - •
APPLICATION FOR PERMIT _
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT,
OF TI�9w
OVERE@AD-OVERSIZE ONE TRIP PERMIT t
` For the ,construction of public or private curbs, driveways; paveme6ts, sidewalks, parking lots, :sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
r Subdivision Improvement Permit ` Class II I
PATE: Dec 11, 1989 Minor Improvement Permit Class IV
r LOCATION OF CONSTRUCTION - 48th Avenue _and Washington
(Street address or Description of Location) '
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION'OF CONSTRUCTION HAUL ROUTE i I :10-Varner Rd',.
Washington
DIMENSION OF INSTALLATION OR REMOVAL -F srrancar REQUIRES TRAFFIC CONTROL/2PILOT .
15°2"..h, 13°6"w. 9011ona
_ VEHICLES PER CALIFORNIA VEHICLE •.
CODE
SIZE OF EXCAVATION,+IF NEEDED
.APPROXIMATE,TIME WHEN WORK WILL BEGIN 1
APPROXIMATE TIME OF COMPLETION _ i A. +;
ESTIMATED CONSTRUCTION COST $
(Including'removal of•all obstruction;,materials, and debris; backfilling, com-
p
actian, and placing permanent resurfacing and/or replacing improvements)
In. consideration.of`the granting of this permit, the applicant hereby agree's 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.' .
: Signature of Applicant or Agent
' Cal Permits 'Inc . PO E,ox 799 San • Bernard i r�() .. t'A L) 7 t1 n 7
800. 344-1'912
Name,of Applicant (please print) .. Business Address Telephone No. i
Name of Contractor and Job' Foreman . Busine`'ss Address :Telephone No. ?'
Contractor's License No. City Business License No.
Farmers Ins. Group f;nn791ti17 '
Applicant's Insurance Company Policy Number = ��
FEES: "Subdivision Improvement Permit - Class I I I '
Public im rovements: 3%of estimated construction costs - 00 t82 10 0443• JL°-it-99, - -
p t0 C.'N i TOTAL 1. i.(i.00•
�. Private improvements: 3% of estimated construction costs
t ?: 48
Minor Improvement Permit - Class IV: See attached schedule ..r,
Inspection Fee $ 'PERMIT VALIDATION. ;
Permit Fee 485
T. .
PERMIT NO.
• Penalty, w ' ..
• - DATE APPROVED'�1 7 /i 1 /spa
Cash Deposit -Surety Bond '
if required �; y 0 '. EXPIRATION DATE •l.y'%11/'89
y •TOTAL: $ lQ„ O DATE ISSUED;,
Re.ceipt No.
By
Received by Date _ ::Administrative Authority -
Recorded by TELEPHONE: (619) 564-2246 "'
H
i
NOTE With proper validation
this form constitut4'an
encroachment -permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OVEREMAD-OVERSIZE ONE TRIP PERMIT
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: Dec 11, 1959 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 48th Avenue and t'ashincst:on
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL - 611 cr�rAncar
F3R
15 r 2°` h, 13 a ��*, 90 ° bnra
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HF.UL ROUTE: I•-10•-Varner Rd,
Wasninaton
REQUIRES TRAFFIC CONTROL/2PILC -'',
VEHICLES PER. CATJF'OR`:'!IA VEHICI, ,
CODE
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(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.
Signature of Applicant or Agent
Cal Permits Inc. PO Box 799 San Bernardino, CA 92402 800 3d4--1912
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.
Farmers Ins. Groin 600221517
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.
10.00
J-C'.00
Received by Date
i ASH 410 AL r 4,0.00
PERMIT VALIDATION
PERMIT NO. 485
DATE APPROVED 12/11/R9
EXPIRATION DATE 11/11/89
DATE ISSUED,
g •�. f r` d
By —
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE: .
With proper validation
this'for"m'constitutes, : ;4 CITY OF LA QUINTA
encroachment permit
l� Y APPLICATION FOR . PERMIEB
T
PUBLIC, WORKS' CONSTRUCTION (ENCROACHMENT) }---
i 4
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
All
" /l/60 TO
Subdivision Improvement Permit — Class II I
DATE: �cG• //, / %��
� M/inor Improvement Permit Class IV
LOCATION OF CONSTRUCTION'------------
����`/��
(Street address or Description of, Location) -
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION %CJ •�`%1e6 '�id�hi��
DIMENSION OF INSTALLATION OR REMOVAL _
r
SIZE OF EXCAVATION, IF NEEDED
` APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATE D.CONSTRUCTION COST $
(Including removal of all obstructiori;, materials, and debris, backfilling, com-•. E
_ paction and placing permanent'resurfacing -and/or replacing improvements) i
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,
i
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.
Signature of Applicant or Agent
Ifo
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 III '
Public improvements: 3% of estimated construction costs k
Private improvements: 3% of estimated construction costs *TO
Minor Improvement Permit — Class IV: See attached schedule lr '
Inspection Fee $ PERMIT VALIDATION '
Permit Fee PERMIT NO.
Penalty
"
Cash Deposit-SurDATE APPROVED
Deposit -Surety Bond , ,-.. � -
if required EXPIRATION DATE
TOTAL: $ DATE ISSUED
Receipt No.
By.
Received by Date- Administrative Authority
Recoeded'by TELEPHONE: (619) 564 2246 i