111341,
NOTE:
With proper validation
this form constitutes an
encroachment permit ' CITY 'OF LA QUINTA
5 APPLICATION FOR, PERMIT »
�: • n1 PUBLIC WORKS CONSTRUCTION„(ENCROACHMENT) ' ` • `;` '
For 'the construction .of public or private curbs, driveways,, pavements, sidewalks, .parking lots, sewers, water mains, j-
and•other like public works, improvements in'connection with MINOR IMPROVEMENTS and`APPROVED SUBDIVISIONS
Subdivision Improvement Permit - Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
-PURPOSE OF CONSTRUCTIONiP...l.il).,.j Sketch-(attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION QXMJk--14JM1j r47 ArEn+
. DIMENSION OF INSTALLATION OR REM9V I: r•S� •� X I �� `
SIZE OF EXCAVATION, IF NEEDED' A) As{/
APPROXIMATE TIME WHEN WORK WILL BEGIN, ' �) #�� i •• f 5
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: _ A
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any'and all
penalties, liabilities or los;;resulting from claims or court action and arising. out of any accident, loss `or damage to persons or propertwi `
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 term's and conditions of the permit and all applicable rules and regulations of the City of
La Quints and to pay for any, additional'replacement necessary as the result df ithis work. '
Signature of Applicant or Agent
Name
of Applicant (please print) Business Address V Telephone No., le
Name of Contractor and Job Forem Business Address V Telephone No.
Contractor's License No t ' City Business License No.
Com} ,- C� -P 14 142 4 `fir
Applicant's Insurance Company Policy lumber-
FEES:
umbe r- 1 "
FEES: Subdivision Improvement Permit — Class III '
K Public improvements: 3% of estimated construction costs
Private improvements:, 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule,' '
Inspection Feer' $PERMIT' VALIDATION "}a• .. ;
Permit Fee
Y :PERMIT NO.
Penalty '
Cash Deposit-Surety Bond DATE APPROVED.
fi ifrequred
iEXPIRATION'-DATE
r
TOTAL: $ i DATE ISSUED
Receipt No y r F
'
By
Received by Date + `Administrative Authority
Recorded, by TELEPHONE: (619) 564-2246 • -3i '
t •r
- n - .- ` - `e„ • ry 1. • � _�+^ •r• <r
.. .. - .. , . ..... .lx` -;'yin y�f• s...• - '.
iv .
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
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: llrny 23► 1991 Minor Improvement Permit Class IV
54-975 Junro2
LOCATION OF CONSTRUCTION
Ln- 0intn, CCS
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION Dr�vc oy
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED mno
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/2"91
Sketch (attach construction plans if appropriate)
Drlvc,uzy approach nuot be
cotkutrucZcd por Riverside County
Standard 10207 (cttachod)
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 this work. ' a"
Signature of Applicant or Agent
Thonno G. $1,aaoy 67 105 IL-an3o lid 322--2059
Name of Applicant (please print) Business Address Telephone No.
Thooms 0. Blaucy 67 105 Itauoro Rd 322-»2059
Name of Contractor and Job Foreman Business Address Telephone No.
507000 0099
Contractor's License No. City Business License No.
Safe Co CP141424A
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
30.00
$ 30.00
Received by Date
10 to
i0
1113
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 5/23/91
EXPIRATION DATE 5/31/91
DATE ISSUEDD A 5/23/91
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an
CITY OF LA" QUINTA
encroachment permit
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: 1"aY 23, 1991 Minor Improvement Permit Class IV
54-075 Juarez
LOCATION OF CONSTRUCTION
La Quinta,'CA
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Driveway Driveway approach must be
constructed per Riverside County
Standard #207 (attached) '
71f DIMENSION OF INSTALLATION OR REMOVAL 5.5 x 16
SIZE OF EXCAVATION, IF NEEDED none
APPROXIMATE,TIME WHEN WORK WILL BEGIN. 6/24/91'
APPROXIMATE TIME OF COMPLETION 5/24/91
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, s,
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./'1 i
Signature of of Applica t;or.Agent---
Thomas.G.'•Blaney 67 105 Rango Rd -322-2059
Name of Applicant (please print) Business Address Telephone No.
Thomas G. Blaney, 67. 105 Rango.Rd 322-2059
Name of Contractor and Job Foreman Business Address A ' Telephone No.
507008 '0099!
Contractor's License No. City Business License No.
Safe Co f,. CP141424A
Applicant's Insurance Company. Policy Number
FEES: Subdivision improvement Permit —.Class I IIp03 j 0 2 5-23•-91 i0..
its CASH i TOTAL1 30.00
Public improvements: 3% of estimated construction costs
Private.'improvements: 3% of estimated construction costs I'll
3.
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 30.00
Penalty
Cash Deposit -Surety Bond
if,required
TOTAL: $ 30.00
Receipt No.
Received by
Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 5/23/91
EXPIRATION DATE 5/31/91
5/23/91
DATE ISSUED
Administrative Authority
TELEPHONE`. (619) 564-2246