0916NOTE:-,
With proper validation
this.form constitutes an CITY OF LA QUINT
ri
encroachment permit
t APPLICATION FOR PER
PUBLIC WORKS CONSTRUCTION (EI
For the construction of public or private curbs, driveways, pavement!
f and other like public works improvements in connection with MINOR IMP
IT
OACHMENT)
sidewalks, parking lots, sewers, water mains
OVEMENTS and APPROVED SUBDIVISIONS
November 16,' 1.990 Subdivision Improvement Permit— Class III
DATE: MinorImprovement Permit Class IV
I r1rATIMI rlF rnnlcTPI Ir'T.M c 54-965 Avenida Vallejo .
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION drivewav approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
etch (attach construction plans if appropriate)
er.Riverside Co.. Std. # 207
ee attached
asap Sib-90 iO,OGiY
APPROXIMATE TIME WHEN WORK ILL BEGIN
O'i8�'AH. iiTOiAI
/50
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) f
In consideration of the granting of this permit, the applicant hereby agrees to!
Indemnify, -defend and save the City, its authorized agents, officers, representatives land 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.
0' `t f
• ` Signature of Applicant or Agent
J V
Vern Embery 54965 Avenida Valleio La Quinta, CA 92253 tll�r
Name of Applicant (please print) Business Address' Telephone Ngo.
Gary Reynolds
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
ity Business License No.
Applicant's Insurance Company ,' 71 Policy Number
FEES: Subdivision Improvement Permit — Class II I ,
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction. costs'
TMt.0
Minor Improvement Permit _ Class IV: See attached schedule N2 . ® 91.` 3
Inspection Fee $ 10.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required,
TOTAL:. $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.' 0916
DATE APPROVED 11/16/90
EXPIRATION DATE 11/30/90
11/16/90
DATE ISSUED,
r•
Administrative .Authority
TELEPHONE: (619) 564-2246
I
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
s
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
DATE
November 16, 1990
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54--965 Avenida Vallejo
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION drivewav approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
per Riverside Co. Std. # 207
see attached
APPROXIMATE TIME WHEN WORii�li��9QN
asap 185i8FASN i�TOTAL 16-94 10.0G 4
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 (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 �oyf this work.
f / 9
Ili
Signature of Applicant or Agent �/I
Vern Embery 54965 Avenida Vallejo La Quinta, CA 92253 ii'LA
Name of Applicant (please print) Business Address Telephone N'o.
Gary Reynolds
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. (t/'`'(,.City Business License No.
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
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 10.00
$ 10.00
Received by Date
Recorded by
3{ 0
PERMIT VALIDATION
PERMIT NO. 0916
DATEAPPROVED 11/16/90
EXPIRATION DATE 11/30/90
DATE ISSUED] 11/16/90
By y 1-41A A _1,
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With propeuvalidationt7
this form constitutes an
encroachment permit
CITY OF LA QUINTA.
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION ( ENCROACHMENT)
For the construction of pubiic. or private curbs, driveways, pavements, sidewalks,. parking- lots, sewers, wratec rMhW>-
and other like public works- improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS',
` f Subdivision improvement Permit — Class ill.
DATE: / w n' Minoullmprovemem Permit -Clan IV
LOCATION OF CONSTRUCTION `S j 5 �'Jy/
tA
(Street crddren or Dawtp6on of Locationh
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CQNST�UCTION � D U vl-
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDEDZIT
Sketch (attach construction plans if app opriiteI=.
APPRO IM TIM EN WORK WILL BEGIN r .
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(including removal of ail obstruction, materials, and debris, ba:kfilling, 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 saw the City, its authorized agents. officers, representatives and employees. harmless from and against any end all
penalties. liabilities or lou resulting from claims or court action and arising out of, any accident, loss or damage to persons or or*" IV
happening or occurring as a proximate -remit of any work undertaken, under- the permit -granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (241 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
LaOuinta and to pay for arty additional repiacarrienr necessem as the result of this work.
Signature of Appiicanor Agent
Name of Aopucant (please printl ` Business Address Telephone No.
Name of Contractor and Job For man Business Address Telephone No:
Contractor's License No. City Business License No..
Applicant's Insurance Company Policy Number
FEES: Subdivision improvement Permit —Class Ill
Public improvements: 3% of estimated construction costs
Private improvements: 3%.of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
insoectlon Fee S
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
' f
TOTAL: $
Receipt No.
Received bV Date
Recorded. by
N0
PERMIT VALIDATION
PERMIT "-40.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: 1619)664-2246