0808h
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NOTE:
With proper validation
this form constitutes an 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 lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: 9q(1 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION TR 24890-1, Jefferson Streot
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION install new cras main Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION I 3916" main
DIMENSION OF INSTALLATION OR REMOVAL 39x2' 6"x48" Reference So. California Gas
L1crr.,iit No.0736
SIZE OF EXCAVATION, IF NEEDED all conditions of permit 0.736
shall apply to this permit
APPROXIMATE TIME WHEN WORK WILL BEGIN x/11/ 10
APPROXIMATE TIME OF COMPLETION 1 day
005 i � ASM � 669-t l0l0-i 14
1-90 4S m UU
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 id all applicable ra/les and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result�lof/t' hisiworkf
Sig694ur,eof Applican/tfor�Agent
Construction p0 DON 783 palm i3osortV,�� c;� / 343-1180
Name of Applicant (please print)
Business
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
2:5961.9
Contractor's License No. City Business License No.
Reliance Ins. Liability Auto/General V61253560
Applicant's Insurance Company Policy Number
556
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 $ 45.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
45.00
TOTAL: $
Receipt No.
Received by Date
Recorded by
v� 080'
PERMIT VALIDATION
PERMIT NO. 0808
DATE APPROVED 8/31/90
EXPIRATION DATE 12/31/90
DATE ISSUED 8/31/9:
f- >
By�.
Administrative Authority
TELEPHONE: (619) 564-2246
— - — — — r r — — — —� r r w.�. r .s .. w.. w. w. r .w.+� r .►. �a .i r w. �Ia w. cv
NOTE:
With proper validation
this form constitutes an 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 lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: ,Aiicrtartt 31, 1996 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION TR 24890-1, Jefferson Street
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION install neer ctc1, a main Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION I 3916" main
DIMENSION OF INSTALLATION OR REMOVAL 39X2 r 6"X48"
"'SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 9/11/90
Deference So. California Gas
Permit No.0736
all conditions of permit 0736
shall apply to this permit
APPROXIMATE TIME OF COMPLETION 1 day
100111 CASH i T91i,08-31-90 450014
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,timewhen work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit am d all applicable r les and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result; of}thisywork�.
r
Signature(of Applicantfor Agent
_Masco Construction PO Box 783 Palm Desert,; CA 343-1180
Name of Applicant (please print) Business Address
Telephone No.
.Name of Contractor and Job Foreman Business Address Telephone No.
239619 560.
Contractor's License No. City Business License No.
Reliance Ins. Liability Auto/General N61253560
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs ,r•
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 45.00 11
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
45.00
TOTAL: $
Receipt No.
Received by
Recorded by
Date
PERMIT VALIDATION
0808
PERMIT NO.
DATE APPROVED 8/31/50
EXPIRATION DATE 12/31/90
DATE ISSUED 8/31/90
By
W Administrative Authority
TELEPHONE: (619) 564-2246