1088NOTE: }
With proper validation _ r�
O
`this form constitutes an
�. encroachment permit CITY OF -LA QUINTA
' APPLICATION FOR PERMIT
•�.y ," PUBLIC WORKS 'CONSTRUCTION (ENCROACHMENT)c
;G 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 . .
�, �:- , • e ' . 1, � - r j
J �" • "April 26, 1991 r - A Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV '
• a -
LOCATION OF CONSTRUCTION diivewa y'a pproach 77780 Calle Chihori, La Quints.
(Street address of Description of Location)
PURPOSE OF CONSTRUCTION widen driveway Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
7' DIMENSI9N'OF INSTALLATION.OR REMOVAL remove approx.
8 of {curb 3 per Riverside Co Std.207
' - see attached (di'lill"gg on original ;
' SIZE OF -EXCAVATION, IF NEEDED ° application)
APPROXIMATE TIME WHEN WORK WILL BEGIN ' 4/26/91
APPROXIMATE -TIME OF COMPLETION `
,ESTIMATED CONSTRUCTION COST$ t'r
i .=-(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:
-, l
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 anFd arising -out of any accident, loss orFdamage 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 AdministrativeAuthorityat least twenty-four (24) hours inladvance of the time when work will be started. r.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and'regulations of the City of
r�
L La Quinta and ,to pay for any additional replacement necessary as the result of this work.
Signature of'Applicant or Agent
1 Thomas 11yeit 77-780 Calle Chillon ,La Quinta
Name of Applicant'(p)ease print) Busines's Address _ -' - Telephone No.
Name of Contractor and Job Foreman Business Address " Telephone No.
Contractor's License No. City. Business License No. '
Allstate : ' 09988618-07/01,
Applicant's Insurance Company a Policy Number
FEES: Subdivision Improvement Permit Class III051 1 9i i 10
iP ' Nsh � fir$ rpt 1 30.00
Public improvements: 3% of estimated construction costs
Private improvements: 3%•of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule r
20.00
Inspection Fee $ - PERMIT VALIDATION
Permit Fee 10.00 PERMIT NO. 1088
Penalty
Cash Deposit Surety Bond DATE APPROVED 4/26/91
May 1, 1991
if required
EXPIRATION DATE
TOTAL: $ 30.00 4/26/91
DATE ISSUED
Receipt No.
By
Received by Date { Administrative Authority
Recorded by I TELEPHONE: (619) 564.2246
ON
NOTE:
With proper validation 0
'this form constitutes an
encroachment permit
r'�1
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
V
April 26, 1991 Subdivision Improvement Permit — Class II I `
DATE- Minor Improvement Permit Class IV
• LOCATION;LOFCONSTRUCTION driveway approach 77-780 Calle Chillon, La Quinta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION widen driveway Sketch (attach construction plans if appropriate)
r DESCRIPTION OF CONSTRUCTION
DIMENSIQN OF INSTALLATION OR REMOVAL remoy6 approx.
8 of curb
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 4/26/91
per Riverside Co. Std. # 207
see attached (draft g on original
application)
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, corn-
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 pKsons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant ljto 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
Thomas Tveit 77-780 Calle Chillon La Quinta
Name of Applicant (please print) Business Address Telephone No.
w
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Allstate 09988618 07/01
Applicant's Insurance Company Policy Number Qp
FEES: Subdivision Improvement Permit — Class I II i805iP2 1 f001 t4 i26T9i30.Ot) i0
Public improvements: 3% of estimated construction costs 0
Private improvements: 3% of estimated construction costs
88
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00 II PERMIT VALIDATION
Permit Fee
10.00
Penalty
` Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by
Recorded by
Date.
1088
PERMIT NO.
DATE APPROVED 4/26/91
May 1, 1991
EXPIRATION DATE
DATEISSUED 4/26/91
Bye'
Administrative Authority
TELEPHONE: (619) 564-2246
I
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
V
April 26, 1991 Subdivision Improvement Permit — Class II I `
DATE- Minor Improvement Permit Class IV
• LOCATION;LOFCONSTRUCTION driveway approach 77-780 Calle Chillon, La Quinta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION widen driveway Sketch (attach construction plans if appropriate)
r DESCRIPTION OF CONSTRUCTION
DIMENSIQN OF INSTALLATION OR REMOVAL remoy6 approx.
8 of curb
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 4/26/91
per Riverside Co. Std. # 207
see attached (draft g on original
application)
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, corn-
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 pKsons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant ljto 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
Thomas Tveit 77-780 Calle Chillon La Quinta
Name of Applicant (please print) Business Address Telephone No.
w
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Allstate 09988618 07/01
Applicant's Insurance Company Policy Number Qp
FEES: Subdivision Improvement Permit — Class I II i805iP2 1 f001 t4 i26T9i30.Ot) i0
Public improvements: 3% of estimated construction costs 0
Private improvements: 3% of estimated construction costs
88
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00 II PERMIT VALIDATION
Permit Fee
10.00
Penalty
` Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by
Recorded by
Date.
1088
PERMIT NO.
DATE APPROVED 4/26/91
May 1, 1991
EXPIRATION DATE
DATEISSUED 4/26/91
Bye'
Administrative Authority
TELEPHONE: (619) 564-2246
!.s
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 111
DATE: ` ( Minor Improvement Permit Clas%',1V
LOCATION OF CONSTRUCTION—
(Street
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION be/ VEZV&1d: Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 4--' a �✓
DIMENSIONOF (INSTALLATION OR REMOVAL
t
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION ?, &'9
ESTIMATED CONSTRUCTION COST $ SO04=
(Including removal of all obstruction, materials, and debris, ba-kfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
do 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, lois 'or damage to persons or property -
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to`thir'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 payfor any additional replacement necessary as the result off this work.
Signature of Applicant or Agent
VVT
Name of Applicant (please print) Business Address Telephone No.
A
Name of Contractor and .lob Foreman Business Address Telephone No.
Contractor's License No.' City Business License No.
8 8% iPi G 7�0/
Applicant's Insurance Company Policy.Number
FEES: Subdivision Improvement Permit —Class 111
Public improvements: 3% of estimated construction costs.
Private improvements: 395 of estimated construction costs NO
Minor Improvement Permit —Class IV: See attached schedule lr
Inspection Fee' $ PERMIT VALIDATION
Permit Fee PERMIT NO.
.Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by _ Date
Recorded by
DATE APPROVED`
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: 1619) 5642246