1026 (2)NOTE:
With proper validation
this form constitutes an
encroachment permit
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y .N
CITY OF LA QUfINTA
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 II I
DATE:Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 76 715 4 75-I Z S 70MP)C_D
(Street address or Description of Location)
PURPOSE OF CO SCTION CON'ST�k ACT DIPME appropriate)
TR . Sketch (attach construction plans if a
AVI
DESCRIPTION OF CONSTRUCTION
6E COkUXULTED P E K •
K U ERS I DE C.C. <:;,TD_
DIMENSION OF INSTALLATION OR REMOVAL UO . Z101 (ATTACHED).
SIZE OF E-XCAVATIONJF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3 `1 2-' q 1
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 his ork.
§ig Aure.of�A p'�ant or Agent
YoLz0UA 15 AQQ- 'KU NE 7LOa1P� 1/ L.i� tJiZ. 1D -77,1,— 1!5
Name of Applicant (please print) Business Address Telephone No.
-
Name of Contractor and Job Foreman- Business Address Telephone No.
k40 -T 7q [i7 Li
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
0
FEES: Subdivision Improvement Permit — Class III �� fl n NOL 3U•0d
' Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1026
Minor Improvement Permit — Class IV: See attached schedule
i�
Inspection Fee $ 2 0' d PERMIT VALIDATION
Permit Fee 10,00 10 Z to
PERMIT NO.
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30 . 0 5...
Receipt No.
Received by Date
Recorded by
DATE APPROVED
EXPIRATION -DATE— 1 S 9 1
"DATE ISSUED\
Administrative Authority
TELEPHONE: (619) 564-2246
ROW
PROPERTY' LINE
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AT COMMERCIAL .
SIVE WA_L K Y
• PROPERTY
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YI "� • !h
X " RES/DEN TIAL /?: M/N. JO' MAX. *X
COMMERCIAL 70'M/N. 40' MAX. • 'MIN .�
WNEN NO SIDEWALK SIDEWALK
EX/STS OR /S. REOVIRED `
I. WHERE. ABOVE LIMIUNG SLOPES CAN NOT
! ,..ALL CONSTRt/CTlJN SHALL BE CLASS "8" BE MET BECAllSE OF N&GNT OF CURB', DEPRESS
CONCRETE' SIDEWALK UNTIL SAID .SLOPES ARE OBTAINED.
"f LewirvO/NAt' SLOPE OF wARPED AREA
Z a0• OF FILL NE16HT CURB REOUIRED ADJACENT TO ORIVEwAr SHALL NOT VARY
6Erwerm /1R/VE WADS w/TNIN ANY MORE MAN, 6 % MOW TKE LONGITUMUL CRADE
ONE FROPERT Y FRONTAGE. LINE OF THE SIDEMUK.
NOTE* MEET Emu S
S4;AEO ORnOE-
TRAUSTION:
R&E Ole VLVMENS/ONS ` r
IIf dWr OF WSU ITIAL COMMfRC/4L w
"'6" I' O I' O" ` T
t
� \ R'pp�EEpS
N. \\\ �IttER�' ,. County 'of Riverside
i CONCRETE
aDRIVEWAY
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S c HEM a ri c APPROACH
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REV/S/ONS
•-:'-" 3-80 STANDARD 'N0. 207,r
8-00-77 2-82
NOTE:
With proper-validetioex .
this form constitutes an- ' CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT. •
o PUBLIC -;WORKS CONSTRUCTION= (ENCROACHMENT)'
For the construction of public' or private curbs, driveways, pavements, sidewalks, parking lots, sewers, wster-� rrtai
and other like public works, improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class 111
DATE: J� / Minor improvement Permit Class IV
LOCATION OF CONSTRUCTION
(street address or Oestxrption of Locamni ;
PURPOSE OF CONSTRUCTION m" j® fi!� i Sketch (attach construction plans if appropl
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 2/=4 r? -
ESTIMATED CONSTRUCTION COST $ A"
(Including removal of all obstruction, materials, and debris, bae-kfilling, com
paction and placing permanent resurfacing- and/or, replacing improvements;
In consideration of the granting of this permit, the applicant hereby agre
Indemnify, defend and saw the City, its authorized agents. officers, reprenni
aenaltres. liabilities or loss resulting from claims or court action and arising
happening or occurring as a proximate result.of env work undertaken under
Notify the Administrat"'Awhority at feast twenty-four (241 hours in advan
Comoly vnth 'all applicable City Ordinances, the terms and conditions of the
La Quints and to pay for any additional replacement neoessism as the result
to:
ives and employees, harmless from and against any end all
it of any accident, lost or damage to persons of property
e permit granted pursuant to this application.
of the time when work vviii be started.
crit and all appikable rules and'regulations of the City of
f this work.' r ""
r
�ee S4rw6f re.of-'.ppiicant or,Agent �9
ame of Applicant (please print) Blcsiness Address Telephone No.
---
Name of Contractor and Job Foreman Business Address elephone No.
Contractor's Lice a No. City Business License No.
Applicant's I surance Company I Policy Number
FEES: Subdivision Improvement Permit —Class Ill
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs NO "
Minor Improvement Permit —Class IV: See attached schedule l
Insoecnon Fee. S I PERMIT VALIDATION
r.
Permit Fee `PERMIT ti0.
V
Penalty - -
ATE APPROVED
Cash Oeposit•Surety Bond,
if required- ,EXPIRATION DATE
TOTAL: $ DATE ISSUED
Receipt No. 8
y .
Received by {Date - Administrative Authority
Recorded byTELEPHONE: W1911 564-2246
NOTE: '
' J� Witlt prope�vatidttlonz: � ._
this form consdam an- CITY OF LA QUINTA,
encroachment -Permit'
APPLICATION .FOR PERMIT
x PUBLIC WORKS .CONSTRUCTION -•.(ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking, lots, -sewers, weber. mains--
and other like public works improvements in connection with MINOR IMPROVEMENTS. and APPROVED SUBDIVISIONS
Subdivision improvement Permit — Class II
DATE: tr """ / Minor ImFovement Permit Class IV
LOCATION OF CONSTRUCTION'
t (Street address or Description of Loationl `.
PURPOSE OF CONSTRUCTION Sketch lattach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR.REMOVAL ,
SIZE OF EXCAVATION, IF NEEDED'. ,
APPROXIMATE. TIME WHEN WORK WILL BEGIN 3
APPROXIMATE TIME OF COMPLETION' 4
ESTIMATED CONSTRUCTION COSTS
(Including removal of all obstruction, materials, and debris, ba -*filling, coni-
paction and placing permanent resurfacing and/or replacing improvements)
In cons ideration"of the.granting of this permit, the applicant hereby -agrees to: '
Indemnify, defend and saw the City, its authorized agents, officers,'reoriafentatives and employees, harmless from and against arhi and all
penalties, liabilities or loft resulting from claims or court,aetion and arising out of any accident, lost or damage to persons or property
happening or occurring aii 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 started:
Comply vnth all applicable City Ordinances, the term and conditions of the permit and all appikabla roles and regulations of the City of
La Ouinte and to pay for any additional replacement neonsary as the result of this f
} o e e � Signa�„tur of AMica t or Agent
of A_,ppucant (please pint)
Name of Contractor and Job Foreman
1�5 _12?
Contra or's I Vcense No. "
Business Address Telephone No.
Business Address Telephone No.
City Business cense No.
Applicaytt'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 *T0.
Minor Imorovement Permit — Class IV: See attached schedule ^ 1\
Insoectlon Fee S I PERMIT VALIDATION
Permit Fee PERMIT NO.
Penalty DATE APPROVED
Cash Deposit -Surety Bond '
if required EXPIRATION DATE
TOTAL: $ DATE ISSUED j
Receipt No. y
By
Received by Date Administrative Authority
Recorded by r TELEPHONE: (8191 5842246 ;