1175t4 -
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: 8-8-91 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53--660 JOAREZ
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION NEW, HOR Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION CUT CMM FOR 711RTVRGIAV
` DRIVEWAY APPROACH SHALL BE CONSIMUCTEi
PER
RIVERSIDE COUNTY STH 207
DIMENSION OF INSTALLATION OR REMOVAL r
.. ., • , F (ATTACHED).'
SIZE OF EXCAVATION, IF NEEDED
I' APPROXIMATE TIME WHEN WORK WILL BEGIN
052 APPROXIMATE TIME OF COMPLETION io CASH � 3TOTAL $S 0-0
APPROXIMATE 14
ESTIMATED CONSTRUCTION COST $ 9An-nn
(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, lossoi'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 6uinta and to pay for any additional replacement necessary as the -'result of this.wer-k:
a' Signature of Applicant or Agen`f
o
Name of Applicant (please print) Business Address - Telephone No. rr:• �;
f SHIM DEVSLOP!lHNT - - 299 SAN PIM 564-6904
Name of Contractor and Job Foreman Business Address Telephone No.
SORBS, DEV LLOND BALKER
., Contractor's License No. F City Business License No.
597564 r
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 75
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
20.00
Permit Fee 19.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ -An. 00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
TELEPHONE: (619) 564-2246
1175
PERMIT NO.
DATE APPROVED
8-8-91
EXPIRAT40 DA
. U
8-1fi-91
8-8-91
D�T
B
Administrative Authority
TELEPHONE: (619) 564-2246
lz
nn
IS,
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
4 Subdivision Improvement Permit — Class III
DATE: T r' Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION &(e O
(Street address or Description of Location) A /I
PURPOSE OF CONSTRUCTION f�rn e Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION O CONSTRUCTION ✓ T &7
�i9 /` V r/ v Q w
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 'ann n—D
(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 ork.
Signature of Applicant or Agent
Name of Applicant (please print) Business Address
/ L Telephone No.
Name of Contractor and Job Foreman
Contractor's License No.
e�— q -7S& Sl
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 $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
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 II I
DATE: 8-8-91 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-660 JUAREZ
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION — NEW RfWF
DESCRIPTION OF CONSTRUCTION rUT rMR Fnu DRIVEWAX
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
DRIVEWAY APPROACH SHALL BE CONSTRUCTEI
PER RIVERSIDE COUNTY STD 207
(ATTACHED)
APPROXIMATE TIME OF COMPLETION 10 05 CASH Oi TOTAL ai OR -9130.00 14
ESTIMATED CONSTRUCTION COST $ 200.00
(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 applicablel rules and regulations of the City of
La Quints and to pay for any additional 'replacement necessary as the result of t
Signature of Applicant or Agent
Name of Applicant (please print) Business Address Telephone No.
BURKE DEVELOPMENT 299 SAN Rl?Mn 566_6gn6
Name of Contractor and Job Foreman Business Address. Telephone No.
BURKE DEV LLOND BAL!ffit 1846
Contractor's License No. City Business License No.
597564
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs - i,
Private improvements: 3% of estimated construction costs
75
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $1 20.00 11 PERMIT VALIDATION
Permit Fee ln_n0
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: . $ 3000
Receipt No.
Received by
Recorded by
Date
1175
PERMIT NO
DATE APPROVED 8-8-91
EXPIRAT —
D T 8-8-91
Administrative Authority
TELEPHONE: (619) 564.2246