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1139i ,> r . A. NOTE: ' With proper validation 2. this form constitutes ano e.CITY =0F LA QUINTA encroachment permit t1w � 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 con nection,with_`MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS _ Subdivision Improvement Permit - Class III DATE: 7-Z 9 Minor Improvement Permit Class IV ' u -LOCATION OF CONSTRUCTION 1 ' (Street address or Description of.Location) PURPOSE OF CONSTRUCTION I�bV� +Ell17imE1Jl- Sketch (attach construction plans if appropriate),,' DEBC�RIPT1pN OF.CONSTRUCTION GZ3 c�t'i"` i119 �-�-;,i" y 132. Ft f 30� o0o L iS - AviE_ 'O � �+5r-�l00We t ' "�a� N F INSTALLATION OR REMOVAL - WAsAIMGr-r �j 10�•R&OY 111' .. DIMENSION 0 SIZE OF EXCAVATION, IF NEEDED L. ZjA--�-*�: -7_Z }4A APPROXIMATE TIME WHEN WORK WILL BEGIN- •APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Includ,ing removal of all obstruction,•materials;'and debris, backfilling, com-- action and placing permanent resurfacing and/or replacing improvements) P P 9 In. consideration of the granting of this 'permit, the' applicant, ,hereby,agrees'to: Indemnify,•defend and save the City, its authorized agents,`officers,represen'taiives and employees, harmless from'and against any and all penalties, liabilities or loss 'resulting from claims or%court ac ion and arising out of any accident, doss or; damage'to persons or,property `u ha enin or -occurring as•a roximate result•of.an ,work undertaken:�under the permit ranted pursuant to this a lication� t ppening 9 P, Y 9 PP , •� _ Notify the Administrative Authority at least twenty-four (24),hours'in advance of the time when work';will'beystarted.. T + f r F' Comply with all applicable City Ordinances` the terms and conditions -of the permit and all applicable rules arid,regulations'of the City of,• La Quinta and to pay for any additional replacement necessary !as -the result of jhiS work. :005&�Ho '2930 07:02 9i :13 OTAL 4 .00 ' Signature, of Applicant or Agent ^ T -E t.�1+�3 cs%54L.45 -I,> ' E. � � S, � � ` (4J. A6N tz -q?lli CAA'ND AZ Name of Applicant (please print) Business Address ,Telephone No:. r -. .Name of Contractor and Job Foreman ° ` , . ' Business Address" Telephone No.. Contractor's License No. City Business License'No. ' 0 t13 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 1139 Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ I PERMIT VALIDATION Permit Fee ' b C1 Penalty Cash Deposit -Surety Bond if. required TOTAL: $ 10,00 Receipt No. _ Received by Recorded by Date PERMIT NO. DATE APPROVED -7—Z— q ' EXPIRATION DATEr7- Z —� DATE ISSUE — Z By dministrative Authority TELEPHONE: (619) 564-2246 t ' �: i t'-.�1 � 1, � - � :, ; �. '� ., �yw T 'aP n ° r NOTE: With proper validation i. this form constitutes an encroachment permit c 1 H CITY OF LA QUI NTA 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: 7-2, Y/ Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION N16yE Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION l✓Z•3 CAT- 13tz 040 LBS �/� �J © 1� E 15 E N H o w a R, -S DIMENSION OF INSTALLATION OR REMOVAL (A.)A5 4114 GrTom 1� }¢rvY f i SIZE OF EXCAVATION, IF NEEDEDVA-11F. p APPROXIMATE TIME WHEN WORK WILL BEGINO "ovjl BEGIN' QC 7 APPROXIMATE TIME OF COMPLETION D+'� ESTIMATED CONSTRUCTION COST $ i (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. . s 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 Ouinta and to pay for any additional replacement necessary as the resul�bis k. 005182 10 2930 07-02--91 13 1 SH i TOTAL 1 10.00 Signature of Applicant or Agent Name of Applicant (please print) Business Address Telephone No. '8o0 — 3-14 I q 1 Z Name of Contractor and Job.Foreman Business Address Telephone No. Contractor's License No. City Business_ License No. Applicant's Insurance Company Policy Number mac,. 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 Permit Fee Penalty Cash Deposit -Surety Bond if. required TOTAL: Receipt No $ 10,00 Received by Date ' Recorded by 1 13 9"' PERMIT VALIDATION PERMIT NO. +,5 9 DATE APPROVED -7-?- q ' EXPIRATION DATE 7- 2' DATE ISSUED By- j&Lr\ Administrative Authority TELEPHONE: (619) 564-2246 FIN NOTE: With proper validation ti this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT.; PUBLIC WORKS CONSTRUCTION (ENCROACHMENTi µ- '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 //9F/ Subdivision Improvement Permit -Class 111 DATE: d 2 � Minor Improvement Permit Class IV v r LOCATION OF CONSTRUCTION (Street address or Description of Location) ' PURPOSE OF CQNSTftUCTION , Sketch (attach construction plans if appropriate); ,fix Trac ��D r' Z 77 T`s�'/ e® -- l Z3 Co J/!� 'Z .-,-,.,,'DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL { ' 11a,' SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN W��-q�vbL "Dq"�s 'Z - APPROXIMATE TIME OF COMPLETION ' ESTIMATED CONSTRUCTION COST S (including removal of all obstruction, materials, and debris, ba,cfilling, 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 NI 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 Quints and to pay for any additional replacement necessary as the result of this work., • t' - � � ' '. - •+ Signature of,Appiicant or Agen Name of Applicant (please print) Business Address°Telephone No. Sa�� j�DO Name of Contractor and Job Foreman Business Address Telephone No. •t - Contractor's License No. City Business License No. ' • 4 Applicant's Insurance Company Policy Number '