0878 (2)NOTE �`' a
'F h
Witli,proper validation,. `
• •this'fo m1constitutes an � �` _ • `" '�' "
CITY,OF LA. QUINTA , {
encroachment permits t . y +
APPLICATION FOR PERMIT •'•
` PUBLIC` WORKS bONSTRUCTION."(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 P
` ' - , ' Subdivision•Improvement Permit'— Class III
r October:. 23 19:0 r
-DATE: Minor Improvement Permit Class IV '
., .
LOCATION -'OF CONSTRUCTION '
'Tract No 0 2.5499-4. PGA West ' • ' � �
~ " (Street addressor Description of Location) - ` y` - . • �t
y . +. P t . i 4 B. a ,+
PURPOSE OF CONSTRUCTION xE'�'t• a ����T��R'*�� `' Sketch -(attach construction plans if appropriate) ,
_ ' aricl •at•nrnn c�raixllaa� '� ,.,, 4 •• • `
*' •DESCRIPTION OF CONSTRUCTION +per approved .plans on• file
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME'WHEN'WORK WILL BEGIN ..(122/An° '' ' • e
"APPROXIMATE TIMEOF,COMPLETION' "- f? ' , }��•
4 ESTIMATED CONSTRUCTION COST $
_ (Including removal ofall obstruction, materials, and debris,backfilling,-com
.placing, permanent resurfacing and/or replacing improvements)
raction and
- t .r• r
In, consideration of the granting .of this/permit, the applicant'hereby,agrees.to:
j Indemnify,•defend'and save the -,City, its authorized agents, officers, representatives and employees, harmless from and. against any and all +
Pena ties, liabilities or-loss~resulting from claims or court action and arising `out of any accident, loss or damagefto persons or propertyt
y '''happening or occurring as a proximate result of any work undertaken under, thepermit-granted 'pursuant'to ,this application.,, ,. `' * '`,..-►�
y 4 Notify the Administrative Authority at least twenty-f6ur124) hours in'advance of the time when work will,be started:
"'' , '• t
Comply with. al1'ap6l i6able City Ordinances, the terms and conditions of, the permit and.all, applicable rules and regulations of the City of.'
,F La Quinta an`d'to.pay 'for any additional replacement necessary as the, result of•this work.
• 5 '* r •'• `/ �-•/� / ��// tom` T_ ,,,.,r_
Signature of Applicanti�or Agent 4.
•Natiohal. Mortgago 'ComAany 42--600 Cook St: • st-e.' Jk Inn Pai:m`'T),A'gM.r•d• _ 'raaY
Name of,Applicant�(please print)' 4 Business Addr'es's..Telephone No: *r I
Name of Contractor and Job Foreman Business Address ; , Telephone No.
y.288130�' •_ �.�
328,.' '"• ' -
Contractor's License,No.r•' ' " " ", City Business License No. x:
Aetna,,, General. Liability% 0 8 3ACM5 7 2 6 7 3 2 ' Wor)azueh IS C0MP ,CKO06873CSA.•
Applicant's Insurance'Company ; * t U .. Policy'Number + r
FEES:. Subdivision Improvement Permit— Class III
+ Public improvements: 3% of estimated construction costs .(jQ 1E82` 7': �23�•9
Rrivate improvements: 3% of estimated construction costs' ,r.,--µ U l AL 1"
Minor Improvement Permit = Class.IV: See attached schedule z ,• y . i
+ Inspection Fee' -► �� $ , �� `� ~� ERM T;VALIDATION
• Permit•Fee A '`,:- .' '.1... ` ♦` y•_ +•• "•. - �t+- ,1, , r
PERMIT NO= : 0870'
Penalty. '. - - •10/<23/90
�. Cash�DepositSurety Bond ' DATE,APPROVED °' r
e
if required--' EXPIRAT ION DATE t4�23,9
TOTAL:
$ 5,325 00, �� ' r •t. I + "DATE ISSUE/10/23/90.D''' �
Receipt No.' 14, �.• „r' ' �Iy ~
BY'"...; •� '
e _ Received by Date ''Administrative Authority
' Recorded by TELEPHONE: (619).564-2246 +, '
e
Y fA I i
rc�...-�wtlba ra'+F.wr Ma�.�Kr Yw Y Mr ►?. •l+ \�,..� v rrr .r... Y s. ♦a 4 .s vN w � M Y r eP' P �+ ,r �� .A w W � r �► .r r w r Y � � r N w M r .► !� !,. b
NOTE:
With proper validation r� Q
this form constitutes an
CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT m
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:
October 2x,1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Tract No. 25499-4 PGA West
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Strnnt iMnrQVC inn+ -.Ca
and storm drainacxe
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1Q%2i/9Q
Sketch (attach construction plans if appropriate)
per approved plans on file
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 191.?,4a • QO
(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 yesult of this work. y
Signature of Applicant"' Agent
National Mortgage Cornany 42-G00 Cook St. Ste. 4 200 Palm Das prt. CA g229n
Name of Applicant (please print) Business Address Telephone No.
same
Name of Contractor and Job Foreman Business Address Telephone No.
288130 328
Contractor's License No. City Business License No.
Aetna, General Liability 083ACA15726732 Tlorkm,!n's Comp CK006873CSA
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs 00 i"2 A 7 k 3-90
_ ;
Private improvements: 3% of estimated construction costst`,dc'L • ��
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 5P12C;_n-.1.
$ 5,325.00
Date
E,
=w
PERMIT NO.
PERMIT VALIDATION
DATE APPROVED
1:
10/23/90
4/23/90
EXPIRATION DATE
DATE ISSUED,. x'10/23/90
By "
Administrative Authority
TELEPHONE: (619) 564-2246