11650
s v.
NOTE:
'With proper validation
this form constitutes an
encroachment permit
r
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 I I I V
DATE JULY 30.91991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION — 54-905 RIMTO
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION ;"NT T14g�Vp��► Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION DRIVEWAY MMANCR
DIMENSION OF INSTALLATION OR,REMOVAL 19x'An
DRIVEWAY APPROACH SHALL BE CONSTRUCTED
PER RIVERSIDE STD #207 ATTACHED
I
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 11.100 •71771 'An
APPROXIMATE TIME OF COMPLETION SAME DAY
ESTIMATED CONSTRUCTION COST $ 1000
ti
(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 resulL.Gfjhis work.
Signature of Applicant or Agent
DAVID RICH 42676 R VELIDT 140-5 ?10;
Name of Applicant (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 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 $ 20.00
Permit Fee 10.00
Penalty '
Cash Deposit -Surety Bond
if.required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded 1.by
:�,-
165
10006 CA 40
P ALO 1 30.00 10
~ PERMIT VALIDATION
PERMIT NO. 1165
DATE AP OVED 7-30-91
D?
PIrRATIO A E 8-2-91
nTdi 7-30-91
By
TELEPHONE: (619) 564-2246
0
Administrative Authority
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 ill
DATE: w ! � �
Minor Im rovement Permit Class IV
LOCATION OF CONSTRUCTION — f, e i7 i c.{ �, J ►� r o
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION )E' `� ��"'� 4 y
71
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 19 3 D
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ��• U� «-�6
APPROXIMATE TIME OF COMPLETION C y
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:
Sketch (attach construction plans if appropriate)
S h49 G L
,4 ITAC,
Co/✓St2uC-%ec1
-G. lb W 2,:,7
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 Quints and to pay for any additional replacement necessary as the result of ork.
- c P
Signature of Applicant or Agent
12 e-, -,) 6, 0,/,A- '/ yo s z
Name of Applicant (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 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 $ ?,0, a
II
Permit Fee /a,o>
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by Date
Recorded by
Itte.S__
PERMIT VALIDATION
PERMIT NO. < < S
DATE APPROVED
EXPIRATION DATE C>Z —C4-
DATE
CDATE ISSUED — 7-- 3 oI'
By
Administrative Authority
TELEPHONE: (619) 5642246
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: JULY 30. t' 1991 Subdivision Improvement Permit — Class I I I
LOCATION OF CONSTRUCTION
Minor Improvement Permit Class IV
— 54-gn5 Rttttrn
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION p14 1N—DRjkHWA
DESCRIPTION OF CONSTRUCTION !)RTVFWAV FNTRANr'r•
-----------
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN t t -nn jttty 'An
Sketch (attach construction plans if appropriate)
DRIVEWAY APPROACH SHALL BE CONSTRUCTED
PER RIVERSIDE STD 4/207 ATTACHED
APPROXIMATE TIME OF COMPLETION SAMR, nev
ESTIMATED CONSTRUCTION COST $ t nnn
(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.
No the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started. 4
Comply with all applicable City Ordinances, the terms 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 resul is work.
Signature 2676 of Applicant or Agent
DAVID RICE
Name of Applicant (please print) Business Address
Telephone No.
Name of Contractor and Job Foreman . Business Address
Telephone No.
Contractor's License No. City Business License No.
Applican't'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 1 1% 6.5
Minor Improvement Permit — Class IV: See attached schedule 005E 8) 10 360 07-30-9
Inspection Fee $
Permit Fee t n Qn
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No. _
Received by Date
Recorded by
10 CAS i TOTAL 1 30.00
PERMIT VALIDATION
PERMIT NO. 1165
DATE AP OVED 7-30-91
E IRATIO
A IS 7-30-91
By
Administrative Authority
TELEPHONE: (619) 564.2246
10