1168f
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 III
DATE: s-2-91 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION ��+—Q�i4 Rich=t��p�1>rd �riva
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION drive approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
be
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Drive way approach shall be constructer
by Riverside County STD # 207
(attached)
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
r 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 o) / 1-y
the time when work will-be,started. -
Comply with all applicable City Ordinances, the teems and conditions of thepefrmit and'bll applicable,rules and regulations of the -City of
La Quinta and to pay for any additional replacement necessary as the result o7this ,
Sighatu(/of Applicantzr Ag4nt
Josephine Reehm Taylor P.O. Cbz 663 La to CA 92253
Name of Applicant (please.print) Business Address Telephone
R�Lr� FL^>ari.�tt�s� Ta�1rR-�c
ell .
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No. ,1,00'
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 $ 090-1)
Permit Fee I.D.
66
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
50 00
Receipt No.
Received by" Date
Recorded by r
pp . 1ii-168 q
,6OSV4H01 3�fbgTj 08-02-9 0. 00 io
PERMIT VALIDATION
PERMIT NO. 1168
DATE APPROVED $02-91
EXPIRATION DATE 8-9-91
DATE ISSUED R-9-91
By
TELEPHONE: (619) 564-2246
Administrative Authority
ti-
;. d + NOTE:
With proper validation
„ this form constitutes an
encroachment permit CITY OF LA QUINTA
APPLICATION FOR PERMIT 83 .
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) •�`
C 0
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: 8-2-91
Subdivision Improvement Permit –Class I I I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION —0A5 t o ti i 2,1 T,
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION – drive approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
Drive way approach shall be constructer
by Riverside County STD 11 207
(attached)
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
penalties, liabilities or loss resulting from claims or court action and arisin out of an a cident, lou or dame a to persons or and all
happeningor occurring as a y y is property
g proximate result of an work undertaken er the ermit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours n advance o the time when work
�nd
d,
Comply with all applicable City Ordinances, the terms and conditi sof the n antySlt"applica ulas tionsoft ity o}
La Ouinta and to pay for- any additional replacement necessary as he result this work
Si atu of E
Josephine Reehm Taylor P.O. Boa 663 La, to CA 922
Name of Applicant (please print) Business Address
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 1 168Q
Minor -Improvement Permit – Class IV: See attached schedule 10005,2 i0i 3TOTAL08i 02-910.00
Inspection Fee $ II PERMIT VALIDATION L
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: L
Receipt No.
Received by Date
Recorded by
PERMIT NO
DATE APPROVED 8-2-91
EXPIRATION DATE 8-9-91
DATE ISSUED
–�–
By
Administrative Authority
TELEPHONE: (619) 564.2246
i0
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 IMP
Permit oY nt Permit Class IV
LOCATION OF CONSTRUCTION `7 [D `"fV _ _ to V1. � I� l A "_ (i Ani n
(Street address or Description of Locati
PURPOSE OF CONSTRUCTION(-_' a r Sketch (attach constructionlans if a
P ppropriate)
DESCRIPTION OF CONSTRUCTION
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, lou 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 124) 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.
9
Name of Contractor and Job Foreman
Contractor's License No.
Signature of Applicant or Agent 77.
a
Address Telephone No.
Business Address Telephone 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 I$
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
e
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 5642246
J
F
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 IMP
Permit oY nt Permit Class IV
LOCATION OF CONSTRUCTION `7 [D `"fV _ _ to V1. � I� l A "_ (i Ani n
(Street address or Description of Locati
PURPOSE OF CONSTRUCTION(-_' a r Sketch (attach constructionlans if a
P ppropriate)
DESCRIPTION OF CONSTRUCTION
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, lou 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 124) 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.
9
Name of Contractor and Job Foreman
Contractor's License No.
Signature of Applicant or Agent 77.
a
Address Telephone No.
Business Address Telephone 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 I$
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
e
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 5642246