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NOTE:
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With proper validations •- r �,Or�
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 _
I and other like public works improvements in connection with'MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit =Class 111
DATE:July 26, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54080 Alvarado L
15treet address or Description of Location) .
roach app
PURPOSE OF CONSTRUCTION driveway _ 'Sketch (attach construction plan`s if appropriate)
.DESCRIPTION OF CONSTRUCTION r.,�,► �,,.a o`,1,�no
DIMENSION OF. INSTALLATION�OR REMOVAL Z3LY
jSIZE'OF EXCAVATION; IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 7/26/90
APPROXIMATE TIME OF COMPLETION -7427/20
ESTIMATED CONSTRUCTION COST $" ?nn nn
(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.
SS g ture of.Appli,a�nt or Agent
Alex Toress 467896 Jeffe son St. Indio 775-1197
Name of Applicant (please print) Business Address Telephone No. .
Name of Contractor and Job Foreman Business Address ".Telephone No.
550498 on fi-1e
Contractor's License No. , City Business`Lice,rse No.
on file
Applicant's Insurance Company r . Policy Number' _ :r
FEES: 4( Subdivision Improvement Permit — Class III c`
Public improvements: 3% of estimated construction costs fR
.-+ 005.182 1U 6183 08—Ui'-90' i0
Private improvements: 3% of estimated construction costs 10 ,< CASH i . TOTAL• i , ' 10.00
�a '0759
Minor Improvement Permit — Class IV: See attached schedule"
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10.00 0759 "
PERMIT NO.
Penalty 7/26/90
Cash Deposit -Surety Bond DATE APPROVED
if requiredEXPIRATION DATE 7 / 31 / 9 0
TOTAL: $ 10.00 3/26/90
DATE ISSUED'f�,, `
Receipt No.
By
Received by Date Administrative Authority
Recorded by ( TELEPHONE: (6 19) 564-2246 .
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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 orprivate 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 II I
DATE: JAW 26, 1990 Minor Improvement Permit Class IV
54080 Alvarado
LOCATION OF.CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION driveway approach Sketch (attach construction plans if appropriate)
ti
DESCRIPTION OFCONSTRUCTION and ronl a6m
v„ rL. X17 n„++ear
DIMENSION OF INSTALLATION OR REMOVAL 23LE.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL -BEGIN 7/26/90
APPROXIMATE TIME OF COMPLETION '7122/0
ESTIMATED CONSTRUCTION COST $ 9AQ On
(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 an work undertaken under the f+
pp g g p y 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 AppR ant or Agent
Alex Tortes 46-896 Jeffe son St. Indio 775 -1197 -
Name of Applicant (please print) Business Address Telephone No.
aarnra
Name of. Contractor and Job Foreman Business Address Telephone No.
550498 on file
Contractor's License No. City Business License No.
on file
Applicant's Insurance Company Policy Number
,4
I fir_
FEES: , Subdivision Improvement Permit —Class III
7�r Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
M Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
If required
TOTA L:
Receipt No.
10.00
$ 10.00
T' Received by Date
Recorded by
005182 10 61%3 08-01--90 10
10 CASM i TOTAL i 10.00
% 0759
PERMIT VALIDATION
0759
PERMIT NO.
DATE APPROVED 7/26/940
EXPIRATION DATE 7/31/90
DATE ISSUED 7/26/90
By
Administrative Authority
TELEPHONE: (619) 564-2246