1064, • y.+ y.. '•"� �-w �r R"! � _r ' f ^'„ " , r _ .,' i~ ' r Jj7 ...,.-r •✓ r %.- 4 ,... � .. ..
NOTE:; "` a. • r , ' 'o, . *.- /'
With proper validation, J -
r this form constitutes an CITY OF LA QUINTA ro
encroachment permit -
f APPLICATION FOR ,.PERMIT ` `
,PUBLIC WORKS, CONSTRUCTION (ENCROACHMENT);
OF
Fo'r the construction
of' public ori private curbs, driveways, •pavements, sidewalks, parking 'lot0,sewers, water mains
"and other like public works improvements in connection with MINOR"IMPROVEMENTS'and APPROVED SUBDIVISIONS
.N • •' ''b , Subdivision Improvement Permit - Class II I`
DATE: -April-16, 1993 . Minor Improvement`Permit Class IV. "
• 54-630 Diaz. Avenue N
LOCATION OF CONSTRUCTION `
(Street address or Description of'Location) _
driveway approach appro'priat'e)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if a
DESCRIPTION OF CONSTRUCTION ' F •q.
DIMENSION OF. INSTALLATION OR REMOVAL 20 1 eat
SIZE OF EXCAVATION, IF NEEDED '
APPROXIMATE TIME'WHEN WORK WILL BEGIN 91
APPROXIMATE TIME OF COMPLETION 1 s
' v , ESTIMATE_ D CONSTRUCTION, COST $ 309000
(Including removal of.all obstruction, materials, and debris; backfilling, com-
paction
om paction and placing permanent resurfacing and/or replacing improvements) `' t
In consideration of the granting 'of this permit, the applicant hereby agrees to: y • °
�
.
Indemnify,:defend and save the City, .its authorized agents, officers, representatives;and. employees, harmiess from and against any and all'i '
S
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 undertakenqunder 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
f - .La Quinta'and to pay for any -additional' replacement necessary as the result of this work. ' t. .-•;« '�
S� nature of Applicant o Agent
Cristobal C. Arroyo 45-250 Smurr.Sr. Indio 347=3115 t
Nam�egoff Aj�plicant (please print) " Business Address ;r ,' �" Telephone No.
Gonatructlon 'same same .
.�. Name of Contractor and'JobForeman,„ _ Business Address u ' '`Telephone No.
1469
Contractor's License No. City Business'License No.
GLS320052
s Applicant's Insurance Company Policy Number ;.
'FEES: Subdivision Improvement Permit — Class I I I
• Q05 0'04-16--9 i0
. ,Public improvements: 3% of estimated construction costs . __. ,,M _ ,. .. Q, I[ i' JOUL •i 0.00
Private improvements: 3% of estimated construction costs 064
Minor Improvement Permit — Class IV: See attached schedule ' 11
20.00 4 M -
' Inspection Fee ` $ PERMIT. VALIDATION . , Permit Fee • ? '1AG PERMIT NO. '1064
Penalty------ - "4/16/91
Cash Deposit -Surety BondDATE APPROVED
if,required EXPIRATION DATE • 4091T
TOTAL: $ 30.00 DATE ISSUED 4/16/91. f
Receipt No. By
.Received by Date Administrative Authority
Recorded by (1 TELEPHONE: (619) 564-2246
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NOTE:
With proper validation r
this form constitutes an
encroachment permit CITY OF ,LA-,QUINTA'.
' APPLICATIONFOR PERMIT,- fg
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
9 Subdiv
DATE: ision Improvement Permit —Class
E Minor Improvement Permit Class IV -
.
V E
c '. � � ""'
LOCATION OF CONSTRUCTION J L� 0/ d 2 �de
L 4 We /-7 r.,111.5, oc
(Street addressor Description of Location) r
PURPOSE OF CONSTRUCTION 1 (fy� �% A �°��'�� ".•Sketch. (attach construction plans if appropriate) t
DESCRIPTION OF CONSTRUCTION 6_LrJ�' r `
a
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME,WHEN.WORK WILL BEGIN
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 undenaken,under.;the permit granted pursuant to this application.
Notify the Administrative Authorityat.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'Appllcani or Agent_
/gy2.54 tiyr sem' j`V.7" 9-
Name of Applicant (please print)` Business Address Telephone No.
�- � �'� f�rrx�.�-S�ror..a+G' ! i s1e�^r . • - � � .. ��� �: • "
Name of Contractor and Job Foreman Business Address Telephone No.
21
Contractor's License No. City Business License No.
c0 L s 3�2'oy�'2
Applicant's Insurance Company Policy Number .
FEES: Subdivision Improvement Permit Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimatedconstruction costs
Minor Improvement Permit — Class IV: See attached schedule f
Inspection Fee $. PERMIT VALIDATION.
Permit Fee' i
r PERMIT NO.
Penalty'
Cash Deposit -Surety Bond �• DATE APPROVED
if required EXPIRATION DATE '
., TOTAL: $
DATE ISSUED
Receipt No. By
t
Received by Date ♦; ;,Administrative Authority"
• �`:
Reeorded. by TELEPHONE: -16191.5642246
_1