1114h vviin proper vanuauon
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 I I I -
DATE: May 23, 1991 Minor Improvement Permit Class IV .
LOCATION OF CONSTRUCTION 53--900Mendoza '
(Street address or Description of Location) }
PURPOSE OF CONSTRUCTION Driveway. appzoC Sketch (attach construction plans if appropriate) ,
DESCRIPTION -OF CONSTRUCTION Driveway '
Driveway" approach must be ;.
,, •, constructed peg Riverside
DIMENSION OF INSTALLATION OR REMOVAL 5.5 k 16 Countq 3tandazd207 (attached}: '
SIZE OF EXCAVATION,';IF NEEDED - none
APPROXIMATE TIME WHEN WORK WILL BEGIN -5/24/91' ' • ''. y+
.,.
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 agree's to: �
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from. `and againstLany 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 asa proximate result of arV 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 spay for any additional replacement necessary•as the result of ,this work.
-Signature of Applicif or A en .
Thomas' G.. Hlaneq 67-105 Rant;o Rd ° , 322 -2059 -
Name of Applicant (please -print) Business Address Telephone No.
'Thomas G. Blaney .67-105 Rango Rd 322-2059 -
Name of Contractpr and Job Foreman . Business Address Telephone No.
.. 507008 0099
Contractor's License No. * City Business License No.
Sofa Co.
4F141424A
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class II I
0 2i 4 p -
Public improvements: 3% of estimated construction c 5 23--91 osts _ . its T TflL i 30. QO 10
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
Permit Fee 30.00 �{
PERMIT NO. '
Penalty 5/23/91
Cash Deposit -Surety Bond.
DATE APPROVED
if required EXPIRATION DATE 5/31/91
30.00 5/23/91
TOTAL: $ DATE ISSUED
Receipt No.. By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 5.64-2246
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
DATE: May 23, 1991
LOCATION OF CONSTRUCTION 53-900 Mendoza
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV f
(Street addressor Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Driveway
DIMENSION OF INSTALLATION OR REMOVAL 5.5 X 16
SIZE OF EXCAVATION, IF NEEDED none
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/24/91
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) _
r
In consideration of the granting of this permit, the applicant hereby agrees to:
Driveway approach must be
constructed per Riverside
County Standard #207 (attached)
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.
Signature of Applicant or Ager]
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 Telephone No.
507008 0099
Contractor's License No. City Business License No.
Safe Co. CP141424A
Applicant'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
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 30.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
3U. 0
Receipt No.
Received by Date
Recorded by
E
i$OSiC S I� 'k'"AL5i23-9130.00 10
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 5/23/91
EXPIRATION DATE 5/31/91
�5/23/91
DATE
T�iC "/B�l�r2 GLfi'\
Administrative Authority
TELEPHONE: (619) 564-2246