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486 (3)Ink . !7,1 , c •. '' . • .• x • r r - 11 r r • p ' , .off NOTE:s «. 1 With proper validation this form; constitutes an �' ' « _ ' •:; ! O� CITY, �OF LA QUI.NTA t o encroachment permit u .,: 4 "' 4, ,. ,APPLICATION FOR `'PERMIT PU`SUIC WORKS CONSTRUCTION (,ENCROACHMENT) A OVERSIZE -OVERLOAD ONE TRIP PERMIT F r ,. For the co struct on of, ;public or private curbs;, driveways, pavements, sidewalks, parking lots,•sewers,-water mains and other like public woi,ks'improvements in connection with.MINOR''IMPROVEMENTS and APPROVED -SUBDIVISIONS :•.' ° • ' '' Subdivision Improvement Permit = Class I I' • DATE: De s 11 r83 Minor Improveme 't•Permit Class IVt. ° LOCATION OF COP�;STRUCTION WASHT4GTON AND FRRD WARTNG PALM ROYALE C • C t FF•5l' a' 1 i i _ (Street address or Description of Location)%*r ` r. PURPOSE OF CONSTRUCTION { _ Sketch (attach construction plans if appropriate) t. •f DESCRIPTION*'SOFC?NSTlR/UCTION, ti�� s�rat7Pr�14'•ti01 .x. ,v HAUL 'ROUTE: 'Washington 'to 'Fred •, .`.I1 127Cn the Taring,, 'turning..'east. on. Fred' Warin DIMENSION& INSTALLATION OR'REMOVAL � REQUIRES COUNTY OF -RIVERSIDE-', PERMIT ° SIZE�OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN r y r + Ao-, t `APPROXIMATE'.TIME OF COMPLETION- • •i5 t[ - - r "Bs •f ESTIMATED CONSTRUCTION COST•$ r • . '(Including removal of al I., obstruction, materials, and debris, backfilling, com` +` t paction'. and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit,,the applicant -hereby agrees to: •' , t y ��r �. 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 undertakers under the permit granted pursuant to this application. ' pt Notify, the Administrative Authority at least twenty-four (24) hours in advance of the time when work will 6e 'started. b , Comply with all applicable City, Crdinances,'the terms and conditions of the permit and all applicable4ules and regulations of the City of La' Quinta and'�to pay for,any additional 'replacement necessary as the result of this,wbrk. r Signatur� a of_Applicant or Agent t, Tamc+o T?i�c�-f`inv+iztriini i'�ac?19 T-Tirthc,ia��' ��r� �.'i'A_ '4 'palm r Name of Applicant,(please print) A Business Address r Telephone No. Name of Contractor and Job Foreman 3 Business Address Telephone No. i Contractor's License No. City business"License.No. °. ' Jerry Young Ins. BA752529 ` Applicant's Insurance Company Policy Number FEES:' Subdivision Improvement Permit — Class III 10 . ` r Public improvements: 3% of estimated construction costs ' `r - l lr' n' } t,YA Private improvements: 3%'of estimated construction costs °t 'Minor improvement Permit - Class IV: See at_tached'schedul'e Inspection Fee $ ; �. ' ' a ' " PERMIT VALIDATION Permit Fee 101, 00 '4 $ 6 PERMIT NO. Penalty H+ I2/11/89 Cash Deposit Surety Bond , ' DATE APPROVED' %if required r : (finn ..EXPIRATION DATE�Rc� t TOTAL: Y DATE ISSUED 12/11/89 Receipt No, BY .. Received by Date - ;` Administrative Authority ` f Recordedbyy f µTELEPHONE y619)r5642246 r." • -. FG 's 1 _ �. " -,} a-.n ,. � ..• ,.i .. rig i 7 r "'ri+i ►-+. r!�+ r�i r++ �+� •.�. a-�n '.� r+ .,ram.. 0.��..� .��. �� �..� �... ...� .•..+ s. .�... ems+. �� �. �� �� �r �� ...�. ..—�. �r �_.. y NOTE_ 4 With proper validation - Q this form constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT For the constru and other like pi PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) OVEI�SIZs":—OVETLOAD ©NE TRIP 1"ERA'II� on of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains is works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement Permit — Class I I I DATE: r,Doc. 11, ID89 Minor Improvern'ent Permit Class IV LOCATION,.OF CONSTRUCTION 11AFRTNGT0V, AND FRED W.ARTNG . PALI' ROYALE C.C. (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION 162-3 scrager 141 61: 3.11611 —, 6 5 1 . 1 1 2 / 0 k3 1-b a DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 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) Sketch (attach construction plans if appropriate) TIAUL ROUTE: Washington to Y red faring, turning east on Free? Warinc. REQUIRES COUNTY OF RIVERSIDE PERMIT 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. r'+ 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 Ta73Qr,f1 TTJcrhui;=,v 111 . Si-p_ 4.Palm Desert. CA 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. Jerry Young Ins. BA752529 Applicant's Insurance Company Policy Number FEES:. Subdivision Improvement Permit — Class tit 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 l ' 0("1 Penalty Cash Deposit -Surety Bond if required TOTAL: $ 10 00 Receipt No. Received by Date Recorded by i 0 t.,A,- :g d 0 ti A.- 1 T& PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE 12/12/29 DATE ISSUED By Administrative Authority TELEPHONE: (619) 564-2246