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0803~'�4y •mak-,. .5 ..- ... �" _ "` r rit NOTE: ; +'_ �' _ •` .� r � � . .« - - . s With proper validation thIjorm,constitutes an j • • CITY OF LA� QUINTA - . encroachment permit r ` APPLICATION ,FOR PERMIT ti PUBLIC WORKS CONSTRUCTION A -ENCROACHMENT) For ;the` construction of public or private" curbs, driveways; pavements, -sidew'alks', parking lots,sewers,'wa'ter mains and; th6r like public works1riiprovements in connection witli MINOR -IMPROVEMENTS and APPROVED SUBDIVISIONS ', .. ,vim - +. •; =M � - S .-�' 't -. xa ..n • i ;_ .. .•+, - •• `'iw - Y t ,•ry.. - - - L Subdivision Improvement Permit = Class, DATE: 8-27-90 ` ' '"` Minor ImprovelnentPermit Class IV.' ••LOCATION,OFCONSTRUCTION OVERSIZE LOAD' (Street address or Description of; Location) PURPOSE Or CONSTRUCTION '` Sketch (attach( construction plans if appropriate) DESCRIPTION OF, CONSTRUCTION r - .-.SOUTH' OF JEFFERSON EAST•�ON 50th' T01, x DIMENSION OF',INSTALLATION OR.REMOVAL Q "u+ i n Q"� CITY LIMITS' 6'0'2v,LONE• — T�, �. . r f 4- HAUL DATE 8-28-90 i ' SIZE OF EXCAVATION,.IF NEEDED' .* r ONE OVERSIZE .TRIP' ONLY t :LAPPROXIMATE,TIME WHEN WORK WILL BEGIN l APPROXIMATE TIME OF. COMPLETION' _ ' _ �_ Y .dry;• ,L ESTIMATED CONSTRUCTION COST, $ «z�r (Including removal of'all obstruction, materials,,an`d:debris, backfilling; com ' ,.,. _ - • •;�' �;• ;paction. and .placing permanent resurfacing and/or, replacing improvements) - - I{n-consideration of -the granting'of this permit, -the: applicant hereby agrees to: �,. '. Indemnify; defend and save the: City, itsauthorizedagents,' officers, representatives and employees;'harmless Irom'and against• any and all - penalties; liabilities or,, loss resulting from claims or court `action'and arising out of,any accident, loss or darnage to persons or. property 3 ,happening: or. occurring as proximate result of any work undertaken under' -the permit granted'pursuant to this'application.; t s.. y ` Notify the• Administrative Authority at least twenty-four. (24) hours in advance' of the time when' work'willr.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,' cessary'.4 the result of this- work. ' Signature of Applicant or Agent,,' i lvtr 'rnr.T.A �•�-'IAT MWV 111 -C'nAC'HFT',T.A­ (`A9 A)293 1-800=344=19k2 Name of,Applicant (please,print) Business Address Telephone No. Name of Contractor and'Job Foreman `. Business Address, Telephone No. ON FILE r_ t. r ml 'FILE' s r Contractor's License No City Busine s Licerise .No. y ON FILE nN FILE ^Applicant's'lnsurance Company Policy Number FEES: Subdivision Improvement Permit•— Class'I II 0p0518'' bb�8 08-27-90 - 10 i0 (~�1SH i 1°UT.AL 1 10 00, Public improvements: 3% of estimated construction costs . Private improvements: 3% of estimated construction, costs 'Minor Improvement Permit = Class IV: See attached schedule + . 1 a ®8 03 Inspection'Fee $ ; r PERMIT .VALID'ATION ` Permit Fee• 1 n nn 0803 . PERMIT NO. Penalty Cash Deposit Surety. Bond DATE APPROVED '' 8-27-90' .. i if required/EXP TON D TE 8'28-90 $_' 10.00 TOTAL: % 1. g-27-90' DATE ISSUED Receipt.No. . t , BY Received by Date Administrative Authority Recorded by. TELEPHONE: (619) 564-2246 ^ .�,-...,.>..�,�.:.�..vjl��,,..,�y��.,`r:.e—..,C,wiU:,`8..,,+^ii`�.'i.+—'�:.,'�"li"�'.:;wY...i"•r%rS'-.�`3-�3^-L-�:.i�}y,:.�.4.Y-'.�t�i•�?d::�.•�ir1'`.+�y.-o....�'.s. , �.h }i• ,y,.,i "�%v. s`'`•-��t1r;t��3.�...r�tx..�,:..r :;mss', . _ :` 1.ale+�aJ•G+i+•livlrit71•�t�-��. 1N. p. w. .i p... ...+w ..1r .r r "�Y.r ri d .t •�... f� d..•'w .w, w w w �s w�.� a.w. r. �. "w -r �.`w. al.M �u�..� .. �'. ,w. .. .F -yL"�y: !� NOTE: , With proper, validation this form constitutes an CITY OF LA QUINTA encroachment permit ; APPLICATION 1FOR. PERMIT - PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)c� 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: 8-27-90 Minor Improvement Permit Class IV ` LOCATION OF CONSTRUCTION OVERSIZE LOAD (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION EAST ON. 50th TO DIMENSION OF INSTALLATION OR REMOVAL IA Q "u 1 n I Q°w CITY_ LIMITS 6 0' 2,.. LONE ' HAUL DATE 8-�28-90' SIZE OF EXCAVATION; IF NEEDED ONE. OVERSIZE TRIP ONLY ."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) 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. r , Signature of Applicant or Agent. M(- f'AT,T•A 5'A -1R1 T4WY 1.1.1 COACPIRLTaA CA9 92236. I-800=344-1912 Name of Applicant (please print) Business Address Telephone No. Name of Contractor. and Job Foreman Business Address Telephone No. ON FILE ON FILE Cont'ractor's License No. City Business License No. ON 'FILE ON' FILE Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit —Class III©©Q5i8"' 6 III' 7-•90 10 i0. (SAS Tt3tA1� Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule 4!3 0803 Inspection. Fee $. PERMIT VALIDATION Permit Fee 1 n nn 0803 PERMIT NO. Penalty Cash Deposit Surety Bond DATE APPROVED 8-27-90 if required ""`" j_ 8-28-90 /EXPIRATION DATE TOTAL: $ 10.00 c . 4 27-90 DATE`I,SSUED Receipt No. X By Received by Date Administrative Authority Recorded by TELEPHONE: (619) 564-2246 NOTE: With proper validation+-, this form constitutes'sn 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 lou, sewers wa>W,,.;,. and otherrlike pubiiwworkrimprovemertts in connection with MINOR' IMPROVEMENTS and APPROVED SUBDIVISION_` 96 Subdivision Improvement Permit — Class 111 ..��_, DATE:—'R((J Minor improvement Permit C1ass.IV LOCATION OF CONSTRUCTION (Street sodran or Oam,pteon at Location► PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION construction plans if 0IMENS ION=OF-INSTALLATION OR REMOVALS SIZE OF EXCAVATION, IF NEEDED ' e6 APPROXIMATE TIME WHEN WORK WILL BEGIN . J r— APPROXIMATE TIME OF COMPLETION 7b ESTIMATED CONSTRUCTION COST $" (Including removal of all obstruction, materials, and debris, bawkfilling, com• f—ry L (M 175 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 saw the City. its authorized agents, officers, representatives and employees, harmless from and against any ed•aU penalties. liabilities or loss resulting from claims or court action and arising out of any accident, loss or darns" to persona -or ptoparel►^ 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 424) 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 Quints and t ora � ionsl reolac""em neoawrwas the result of this work. Signatureof A plicant or Agent / /} Name of Aopucant (please pnii 1 Business,Addre s Telephone No. x; Ledb Name of Contractor ano J b Foreman Business Address Telephone No. CY\ Contractor's License No City Busine'S4 License No. Applicant's Insurance Co pang Policy Number FEES: Subdivision lmorovement Permit —Class Ill Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs N? Minor Imorovement Permit — Class IV: See attached schedule insoectlon Fee S ` PERMIT VALIDATION P-rmit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by , Date PERMIT N0. DATE APPROVED EXPIRATION DATE DATE ISSUED - By Administratft,Authority _ Recorded by 11 TELEPHONE: -(619) 664-2246,