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0954NOTE: i With proper validation this form constitutes an Ok encroachment permit ° CITY OF LA �QUINTAY APPLICATION.. FOR • PERMIT #, PUBLIC WORKS `CONSTRUCTION '(ENCROACHMENT) • c J'S��R For the: construction of public .or private curbs, `driveways, pavements, sidewalks,.parking lots,. sewers, water mains hand other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.. i, 'Subdivision Improvement Permit --Class II I , December, ,7 1990 yr. DATE: ' Minorjmprovement PerrnitClass IV LOCATION OF CONSTRUCTION 'driveway, approach 54700' Avenida _Rubio ' P a, (Street addressor Description of Location) PURPOSE OF CONSTRUCTION fir; s Sketch (attach, construction plans if appropriate), Refer to RiVe'r�side 'Coun.ty :.a DESCRIPTION OF CONSTRUCTION CONCRETE •DRIVEQAY'APPRDACH. 7.r` "STANDARD NO', 207 attached' - DIMENSION OF INSTALLATION OR REMOVAL SIZE.OF EXCAVATION, IF NEEDED APPROXIMATE TIME'WHEN,WORK WILL BEGIN (1 9/1 n /dn APP ROXIMATETIME.OF COMPLETION ESTIMATED CONSTRUCTION.COST $ �, . (Including. removal of.all obsfruction,-materials; arid debris, backfilling; com `*> paction-and placing ,permanent resurfacing :and/or replacing improvements) ` ` In conside'ration-of the granting of this`permit, the'applicant hereby' a'rees�to h _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 eny 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. r < Comply with'all applicable• City' Ordinances;ttheiterms and Conditions`of'the,.permitand all applicable rules and regulations of the City of s :; ' La Quinta and to pay'for any additional replacement necessary, as the result of this work.T. /Signature of 'Applicant or)Agent Slirley: Stephan 'PO Box 26S "La Quinta,. CA` 342-8533- r Name of Applicant (please print) :. �� `Business Address ,Telephone No.. ' { ' , "Name of Contractor and Jab Foreman '• i '{ ' ^ Business Address Telephone N'o. 536617 ' Contractor's License No:. r City Busiriess`License'No. ,. Allstatie' Applicant's Insurance Company Policy Number FEES: - Subdivision hmprovement Permit— Class I I l,• . r - - 005i82 10-8585•i2- 07-90 i0 Public iniprovements:'3%of estiinated construction costs i0�I CASH i •TOTAL i' " 30:00 Private improve ments:'3%of.estimated construction costs IN 6 r ' Minor Improvement Permit— Class IV: See`attached schedule Inspection Fee $ 20.00 PERMIT VALIDATION Permit Fee .� 1'0 00 0954' PERMIT No. Penalty. { +12/7/90 I•,. Cash Deposit -Surety Bond F, DATE«APPROVED if required EXPIRATION DATE 12/14/90,-' TOTAL:. $ 30.00 12/7,/.90 DATE ISSUED Receipt No. By f ' Received by Date Administrative Authority ' Recorded by TELEPHONE: (619) 564-2246 NOTE: With proper validation this form constitutes an encroachment permit ti J-0.. �++w. w+. �► a P ..F` !4 we../4 !!� w .l•� lam' �1�^ T,� dM, 4 �b M1 w„k �'��t � !ff�!.- sn f1F f+ 1�. Mew. M wr 4 l.�• � 'M. M •!J� s CITY OF LA QUINTA 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 DATE December 7, I S 9 C Subdivision Improvement Permit— Class III Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION drive -way approach 54.700 Avenida Rubio (Street address or Description of Location) PURPOSE OF CONSTRUCTION rir�Rsur��r a+�t�re►Q1, DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Sketch (attach construction plans if appropriate) Refer to Riverside County CONCRETE DRTVE119AY APPRQACH STRNDARD NO. 207 attached 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 of this work. ,Signature of Applicant or Agent 'F Shirley Stephan r%O Lox 365 La"Puinta, CA 342-8533 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. 536617 Contractor's License No. City Business License No. Allstatie Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class I II 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. Received by $ 20.00 1G.Oa $ 3G.GC Date 005,02 ASH 8i �%`�4C f 07-70 to 30-00 PERMIT VALIDATION PERMIT NO DATE APPROVED 0954 12/7/9Q EXPIRATION DATE 12/14/90 DATE ISSUED 12/7/90 By Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 A � NOTE:. • , , ' .With propervalidstionj-j- this form constitutes:ani encroachment permit K CITY` OF LA QU1NTA' ` • APPLICATION FOR�.PERMIT " ,y ,,PUBLIC- WORKS". CONSTRUCTION- (ENCROACHMENT) For, the construction of public'r;r "private curbs, driveways, pavements;)sidewaiks- parking lots; sewers; waterinairts and other like public worksimprovements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS:'-. Subdivision Improvement Permit — Class III -DATE: y �' Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or, Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) -- DESCRIPTION OF CONSTRUCTION' DIMENSION OF INSTALLATION OR REMOVAL ; SIZE OF EXCAVATION, IF NEEDED • APPROXIMATE TIME WHEN WORK WILL BEGIN j T1 I APPROXIMATE TIME'OF.COMPLETION ESTIMATED CONSTRUCTION COST $ , (Including removal of all obstruction; materials, and debris, bard*filling, com- paction and placing permanent resurfacing and/or replacing improvements) . ` In consideration of the granting of-this,permit,•the'appiicant hereby�agrees.to, r ° 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 tosperscris or wcpartYry 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'swrted. •Comply*with all applicable City Ordinances; -,the terms and conditions of the.permit and all applicable ruin and regulations of the -City of - La Quints and to pay for any,additional recieeament•necessary as the result of this work. r ` Signature of ApplicaYnt o Agent Narne of Appiicant (' lease -print) - Business Address Telephone No. � ham; �; ..,w 4 �x Vic; s :Y -.� , 3..a s, t. Name of Contracto -and Job Foreman Business Address Telephone No. Contractor's License No. {, . r. City Business License No. Applicant's Insurance Company "•` �, Polity Number w ,:'f FEES: Subdivision Improvement Permit — Class 111 ' Public improvements: 3% of estimated construction costs Private improveinents: 3%of estimated construction costs �T Minor Imorovement Permit — Class iV: See attached schedule lr �' insciection Fee S PERMIT VALIDATION Permit Fee s� PERMIT N0.' Penalty Cash Deposit -Surety Bond DATE APPROVED if required ' C_�___ EXPIRATION DATE TOTAL: • DATE ISSUED Receipt No. • . _ Received by �' Date BY Administrative Authority .. Recorded by TELEPHONE: (619) 5642246= .. • .. 0 •