1010' Y •
c.
• NOTE: r
With proper. validation
this form constitutes an
CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
of TRB�wS
For the construction of public or private curbs, driveways, pavements, sidewalks, parkinglots, sewers,'
water mains
and other like public works improvements in connection with MINOR"IMPROVEMENTS and APPROVED SUBDIVISIONS
',Subdivision Improvement Permit —Class III
DATE: February" 12, • 1991 Minor Improvement Permit Class IV
- LOCATION OF'CONSTRUCTION A000 Carranzaj La, Quinta,
(Street address or Description of Location) - a
_
PURPOSE OF CONSTRUCTION driveway approach Sketch (attach construction-plans if appropriate)
DESCRIPTION OF CONSTRUCTION per Riverside County Standard
No. 207 (attached)
DIMENSION OF INSTALLATION OR REMOVAL
_ SIZE OF EXCAVATION, IF NEEDED
�A Ti�� TA -12-91 30.044
APPROXIMATE TIME WHEN'WORK WILL BEGIN 214/91
APPROXIMATE TIME OF COMPLETION 2/15/91
ESTIMATED CONSTRUCTION COST $ .
(Including removal of all obstruction, materials, and debris, backfilling, com
, r
paction'and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to: -
Indemnify, defendcand 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.pe►sons or,propeI rty U
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 advanc oft time when work will be-(Started. k
Comply.with all applicable City Ordinances, the terms and condition's of he per t and all applicable rules and regulations of the City Of.
La Quinta and to'pay for any additional replacement necessary as,the result o this work. `•
c`
e Signature of Applicant or Agent ,
R.J. Sirak' PO Box 338 Palm Desert, CA 92260 •345-7974
Name of Applicant (please print) Business Address Telephone No.
same ,
Name of Contractor and Job Foreman Business, Address r Telephone No.,,
25767.0 ;
Contractor's License No. City Business License No.
Applicant's Insurance Company' Policy. Number
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 $ 2000 PERMIT .VALIDATION'
10.00 1010
Permit Fee PERMIT NO. -
Penalty 2/12/91
Cash Deposit-Surety Bond DATE APPROVED
if required EXPIRATION DATE 2/15/91
TOTAL: $ 30.00 /12/91
- DATE ISSUED
Receipt No. By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
+tai.• .s ry.... Vl� W 't [- '•�'t `Y�:'jJ -- _.. .. . •... a, : x i • '— .. '9 ^ .a-'.r�47' ^."Nt�•`t�*.�:Rct` w•'�w.: •w•{y.�.�,r..
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I
I
NOTE:
With proper validation
this form constitutes an
encroachment permit 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
Subdivision Improvement Permit— Class III
DATE: February 12, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 00 Carranza, La Quinta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION per Riverside County Standard
No. 207 (attached)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED �p Z p
ff5'% P13TUT-9i 30.04'
APPROXIMATE TIME WHEN WORK WILL BEGIN 2/14/91
APPROXIMATE TIME OF COMPLETION 2/15/91
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 thi application.
Notify the Administrative Authority at least twenty-four (24) hours in -adv nc 2it
time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of he pernd all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result o this work.
Signature of Applicant or Agent
R.J. Sirak PO Box 838 Palm Desert, CA 92260 345-7974
Name of Applicant (please print) Business Address Telephone No.
same
Name of Contractor and Job Foreman Business Address Telephone No.
257670
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
ry
FEES: Subdivision Improvement Permit — Class I I I f
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
20.00
F
Inspection ee $
Permit Fee
10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00 ,-
Receipt No.
Received by
Recorded by
Date ..t,. ,
t
10,10.
PERMIT VALIDATION
PERMIT NO. 1010
DATE APPROVED 2/12/91
EXPIRATION DATE 2/15/91
DATE ISSUED 2/12/91
.rte
By
+ s' Administrative Authority
TELEPHONE: (619) 564-2246