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0875140TE: . With proper validation this form constitutes an encroach ment_permit ;'m,�Yi,,:ar;.,�;-�'v-�ti"�= :��. `.,u.;:� w.•-.:�-#:..1 z w-�", :�';:: v�.•- . � - ..-ti .' . To.�—.r.., ,.s.i_.:, t. '�,.r , -.' _! .. .�; ,� . �. r r . — - — + CITY OF LA QUINTA APPLICATION FOR PERMIT P. UBLIC -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 I DATE: Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION LAEA) F1ouc�,n:AF_tJT DESCRIPTION OF CONSTRUCTION ��' 3 a RF 1Z DIMENSION OF INSTALLATION OR REMOVAL Irl ' H 1/) ' 1i11 SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN I012� iq© Y Y Sketch (attach construction plans if appropriate) HA_ AL MATE SZ "hi -MILL EAST OF WASH liMCYToN We TO WAsI-II QG_T0K1 N DeTN TO ?� Wy 1 t 1 -TO: CATY L 1 CJI ITS APPROXIMATE TIME OF COMPLETION WA1AL DATA. Ib' 23'r�C 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�',Applicalnt or Agent t�UE�o 1tilye,It�� f�1tic) -7a-Gil olk"Tt-Y CLIkE-L.) ?5V7EAXtAD1%)E7S Name of Applicant (please print) Business Address Telephone No. f '160 —Tk AC ti 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 -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 Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: . $ 10.00 Receipt No. Received by Date 0?,5182 AO 14 J. TOTAL -1 50.00-21-90 0 0875 PERMIT VALIDATION PERMIT NO. 0.87s DATE APPROVED EXPIRATION DATE DATE ISSUED' -ZZ- 90 By J © Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 . ,?,� ;''f'+r�l1r'�•.Y•'L;';- �.�+���' ;vS�..`�b! �.7^'*•rt�w w•� .sv?`Dw'►Jr'`�;, �-i"V�.Yi':�� ;>,%.k �� y�»s'.r•. w.:�,*iFt;',�1'iy!�°Yx4ea��•x ��M7C,'fN �Fl ' 4 ',+ra' , d��M 7 W A" pA' �. p.• i•�r r+u /:• WI sG-.w1"S� �Y wl �w M' O �u r _ _ ` _Cr B Md.• M M .Pl. W B 4Y , Y 4 T•11+ r �!I"Y IIT �i 11� CM r'� M !�'W.'M� !J, li. 'R''6. DOTE: ) With proper validation 4 2 this form constitutes an.... J 'CITY OF LA' QUINTA r encroachment permit..••. � • - _ , . � • APPLICATION. FOR PERMIT - PUBLIC WORKS. -CONSTRUCTION (ENCROACHMENT) ov�.�sIL..I~ , y.ofi©':�.si"r c�oFTH$�wS For'the' construction of public or private curbs,' driveways, pavements, sidevvalks,"'�parkirig lots, sewers,' water, mains ' and .other like public works improvements in connection with,MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS ; �'' •Subdivision Improvement Permit —'Class II f: DATE: C1 0Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION` - • • � , _ gam;''„' i 3 ' (Street address.or.Description of Location) PURPOSE -OF CONSTRUCTION F��a ► Sketch (attach construction plans if appropriate), _ DESCRIPTION OF CONSTRUCTION 4/1- ea � ZAI>Ir_ Imo' ���� 90- 1A E SSZ 'Jja MILS EAST OF WASH IhIC-,,7`©M DIMENSION OF'INSTALLATION OR REMOVAL !'4 A f . �U ' Ik ) / TO�n/14� i'al Q � Q�l. N O ' f i 9'i � , • I :.r �� ,, - 70 R wlr HA ' `T Q C)T Y L i t�s11 `r a SIZE.OF,,.EXCAVATION, IF NEEDED •;• APPROXIMATE TIME WHEN•WORK WILL'BEGIN ` ; APPROXIMATE,TIME`OF.COMPLE,T`ION +` ESTIMATED CONSTRUCTION COST $ '"AIAL d E 1 90 (Including removal of all'obstruction, materials, and debris, backfilling, corn paction'and placing permanent resurfacing and/or replacing improvements) ” In consideration of the granting of this permit,�,the applicant hereby ,agrees to`. 1 Indemnify, defend and -save the City, its au'thiized agents, officers,' representatives and employees, harmless from and against any and all N. " 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_ t, La Quinta and to pay for any'additional 'replacement. necessary as the result of this work. ;, , •. kvf 1. Sig ature of;Applicalnt or Agent WGNF40. _..K16INtU)1X) 7qI gil, t'oamTzy r- CIA -.?)V-'tMLAC)A 1-�M, C -S ;r 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. Y s°st•) F I L -ice, Applicant's Insurance Company Policy Number FEES:,' Sulidivision Improvement Permit — Class III Public improvements: 3% of estimated construction costs " 0.82 4 -2?'90 10.0 0� Private.improvements: 3% of estimated construction costs '"t p Mirior.lmprovement Permit —Class IV: See attached schedule 6 �2 •.10 8 7 5 - inspection Fee $ { PERMIT. VALIDATION . s� 1 Permit Fee PERMIT NO.. Penalty j Cash Deposit Surety Bond"" ' .'r DATE APPROVED �.. , if required . 3 Z ' EXPIRATION DATE' 69 6 'a ( TOTAL: $ '101 6Q t DATE ISSUED /0 q 'k. Receipt No.",.. t • �f�.�0�� .�`7tGj2/#�a��//1�._ ' By a' Received'bY Date 'Administrative Authority Recorded by TELEPHONE: (619) 564-2246 ___._�._ _. �_r_,__�_�_r_._____ ___.___ �_ .� TOTE: Vith proper validation Ms form constitutfies an CITY OF LA QUINTA 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 Subdivision Improvement Permit — Class 111 SATE: L) - Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or ()ascription of Location) } PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) �S- IO DESCRIP ON OF H IV DIMENSION OF INSTALLATION OR REMOVAL _ 4 SIZE OF EXCAVATION, IF NEEDED �.pr -1 h A -o 1-ku �-j 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 1241 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 Ouinta and to pay for any additional replacement necessary as the result of this work.. Signature of Applicant or Agent Nuevo Engineering, Inc. 79-811 Country Club Bermuda Dunes 619-345-1778 ame of Applicant (please print) Business Address Telephone No. T�C�brl of Contractor and Job Foreman License No. Business Address . Telephone No. City Business License No. Epplicant's Insurance Company Policy Number EES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule n Fee $ it Fee ish Deposit -Surety Bond required TOTAL: aceipt No. $ eceived by Date by N° 0�7� PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE: (619) 564-2246 it I