1033NOTE:
With proper validation f
this form constitutes an CITY OF LA' QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
' r a
For the construction of public or private curbs; driveways, pavements,' sidewalks, parking lots, sewers, water mains
•and other like public work's improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
Subdivision Improvement Permit - Class III .
DATE: March` 18 1991 Minor Improvement Permit Clas`s]V
LOCATION OF CONSTRUCTION 53-980 -Avenida Cortez
(Street address or Description of Location)
driveway approach
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION st r -
r
.per Riverside County Std'., 4207'
r DIMENSION OF INSTALLATION OR REMOVAL see.- attached 4
SIZE OF EXCAVATION, IF NEEDED '
APPROXIMATE TIME WHEN WORK WILL BEGIN 311A 191 , M
'APPROXIMATE TIME OF COMPLETION 312 2/91
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 this application., Y
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. s
ignature of Applicant or Agent'
Steve Bastasini PO Box 51.32 La Quinta', CA 92253 564-49431=
Name of Applicant (please print) Business Address %Telephone'No.
Name of Contractor and Job Foreman Business Address • Telephone No.
31.36 :
Contractor's License No. City Business License No.
.Applicant's Insurance.Company Policy Number
FEES: Subdivision Improvement Permit —Class III
_ Public improvements: 3%of.estimated construction, costs.A� i7►i�0-91 30,00
Private improvements:,3% of'estimated construction costs O fj _
Minor Improvement Permit — Clas's IV: See attached schedule J
Inspection Fee $ 20.00 PERMIT VALIDATION
Permit Fee 10:00 PERMIT NO. 1033
Penalty
DATE APPROVED 3/18/91
Cash Deposit -Surety Bond
if.required EXPIRATION DATE 3/22/91
TOTAL: $ 30.00 DATE ISSUED 3//18/91
Receipt No.
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
1
�' � ..
•
� t ..
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 publ'ic or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
s and other like public works improvements in connection with,MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
4.
Subdivision Improvement Permit.— Class II I
DATE: March 18, 1991 Minor Improvement Permit Class.IV
LOCATION OF CONSTRUCTION 53-980 Avenida Cortez
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION driveway approach Sketch (attach constructionif lans a
p ppropriate)
DESCRIPTION OF CONSTRUCTION S r
per,Riverside County Std. #207
,DIMENSION OF INSTALLATION OR REMOVAL see : attached -
SIZE OF EXCAVATION; IF NEEDED .
` APPROXIMATE TIME WHEN WORK WILL BEGIN 3/18/91
f
`. APPROXIMATE TIME OF COMPLETION 3/2.2/91
ESTIMATED'CONSTRUCTION COST $
F (Including removal of all obstruction,. materials, and debris, backfilling, cum
paction and placing permanent resurfacing and/or replacing improvements►
4 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
f happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
'C Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
I 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.,
f• gignature of Applicant or Agent
Steve Bastasini PO Box 5132 La Quints, CA'92253 564-4943
Name of Applicant (please print) Business Address Telephone No.
i
Name of Contractor and Job Foreman Business Address Telephone No.
3136
Contractor's License No. City Business License No.
Applicant's Insurance Company -Policy Number "
P• FEES:, ,Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costsiRf$7ITO
�8-5�1 30.00
Private improvements: 13% of estimated construction costs
.1033
Minor Improvement Permit— Class IV: See attached schedule .
Inspection Fee $ 20.00 PERMIT VALIDATION'
10.00
Permit Fee 1033
Penalty
Cash Deposit -Surety Bond
if.required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
PERMIT NO.
DATE APPROVED 3/18/91
EXPIRATION DATE 3/32/91
DATE ISSUED 3//18/91
By
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE: `• t # • r • e .,.• With proper-vaii k6mr:,. ,
this form constitutes sn ,
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. mapts
and other like public works improvements in connection with MINOR IMPROVEMENTS andAPPROVED SUBDIVISIONS
Subdivision improvement Permit — Class 111
DATE: i �,I 1' - Minor Improvement Permit Class iv,
LOCATION OF CONSTRUCTION S c18
(Street address or Oesenption of Location! '
PURPOSE OF CONSTRUCTION Sketch (attach construction pians if appropriti) _ *3
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR,REMOVAL
SIZE OF EXCAVATION, IF NEEDED : • #
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION S -
ESTIMATED CONSTRUCTION.COST.S
(Including removai.of all obstruction, materials, and debris, ba*filling, com=
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of,the.granting•of this permit, the.appiicant hereby agrees to:
Indemnify, defend and'seve the City, its authorized agents. officers, representatives and employees• harmless from and against any and alt
penalties: liabilities or loss resuiting -from claims or court action and.arising out of anyracndent, loss or damags to persons or property
happening or occurring as a proximate rmit of any work undertaken under the permit•granted pursuant to this application.
• I 4
Notify the Administrative Authority at least twenty-four 1241'hours in advance of the time when work will be started.+
Comply wnh all applicable City Ordinances, the terms and conditions of the permit and all .smile able rules and regulations of the City of
La Quints and to pay for env additionsi,repiaarnent necessary as the remit of this work.
07
Signature of Applicant or Agent '
Name of Appucant (please print) Business Address Telephone No.'
-Name of'Contractor and Job Foreman Business Address Telephone No.
Contractor's License No'. ' • City.Business License No.
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
No'. ,
' Minor Improvement Permit— Class IV: See attached ichedule r
. Inspection Fee S ""
` PERMIT VALIDATION
Permit Fee " PERMIT ti0.
Penalty DATE APPROVED
Cash Deposit.Surety Bond
if required EXPIRATION DATE
• r
TOTAL: $ OATS ISSUED
Receipt No:
By
Received by Date Administrative Authority
1 Recorded by ` " TELEPHONE: (619) 6642246