11773' , S
r
NOTE.: v
With proper validation
this form constitutes an CITY OF, LA QUINTA'
encroachment permit
APPLICATION) FOR PERMIT
PUBLIC WORKS CONSTRUCTION _ (ENCROACHMENT.)
f y 0F Opti
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: 4...&—Q1 Minor Improvement Permit Class IV
4 LOCATION OF CONSTRUCTION — PAbTO SESS70N fr1ASMC.TON
(Street'address or Description of Location)
PURPOSE OF CONSTRUCTION PHOTO SESSEON_ - Sketch (attach construction plans if"appropriate)
DESCRIPTION OF CONSTRUCTION C SBH #0321 ,
VIOLATION #14.16.040 XC
DIMENSION OF INSTALLATION OR REMOVAL r
SIZE OF EXCAVATION, IF NEEDED
APP_ ROXIMATE'-TIME WHEN WORK WILL BEGIN
005"�g2 '10 38 08-12'-91 14
APPROXIMATE TIME OF COMPLETION 10 CASH 1 TOTAL i 10.00
-,ESTIMATED CONSTRUCTION COST $
'i (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.
t 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 ent
XM BAYNE 742 HOLBROOK SUNNYVALE C.A. 94087 213--5'50-1596
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.
Appl'icant's Insurance Company `. _ Policy Number
FEES: Subdivision Improvement Permit — Class III
Public improvenients:,3% of estimated construction costs
7 Private improvements: 3% of estimated construction costs ,, 1 i T -
..J Minor Improvement Permit — Class IV: See attached schedule g
Inspection'Fee$ PERMIT VALIDATION
l Permit 10.00 Fee y PERMIT NO. 1177
Penalty
Cash Deposit -Su rety.Bond
if, required
TOTAL:
Receipt No.
Received by
Recorded by
$ 10.00
Date
DATE APPROVED 8-9-91
EXPIRATION DATE 4-5-91
DATE IS UED 46"'91 1—L
By -
Administrative Authority
TELEPHONE: (619) 564-2246
B
C. C. SIMPSON
CLERK/ADMINISTRATOR
CAROL L. REED
ASSISTANT CLERK/ADMINISTRATOR
Engineering Dept.
City of La Quinta
P.O. Box 1505-
La
505La Quinta, CA 92253
04E fitllnitipal Tourt
DESERT JUDICIAL DISTRICT
COUNTY OF RIVERSIDE
August 8, 1991
city sof bs Quinta
AUG 0 s 1991
PUBLIC WORKS
3255 EAST TAHQUITZ-McCALLUM WAY
PALM SPRINGS, CA 92263.2728
(619) 323.8521
82-675 HIGHWAY 111
P.O. DRAWER BBB
INDIO, CA 92201.2552
(619) 342.8204
260 N. SPRING STREET
BLYTHE, CA 92225
(619) 922.8128
Reply To
Please be advised the court will accept a back dated permit issued
in the name of Mark Kane as proof of correction on his citation.
S.�qe
Linda McIntyre
Judicial Services Supervisor -Traffic
- � '- gyp' i•.. P .
r•; j
P.V. Box 1306 70-10.5 C Jfe H.1^4a Lo Caul—. CJ% 92229
(619) 564-1246
WAXY (619)564-$4517
YJ&C;SXM1X.1M 'rFtA1-4SNZ1gr-I a7 -
B'os A'l�+
t €..
•2 _ 1
FAX Numbers - -1 =�� �1�-.� S r-Mrouns
YTate Santa 1
,rbne Soames `� °• (-i i-�-
Additional Conunentas
� e
Q
_,fid � a c.1 �.. _ Lam• . v 9"�'�_ �1 �Sfi � IG— � ��-�. �•-� �
TRANSMISSION REPORT
THIS DOCUMENT (REDUCED SAMPLE ABOVE)
COULD NOT BE SENT
COUNT
# 0
*** RECEIVE ***
NO
REMOTE STATION I.D.
I START TIME
DURATION
#PAGES -1
COMMENT
1
8-12-91 8:44AM
0'20"
0
OP71/ OK
TOTAL 0:00'20" 0
XEROX TELECOPIER 7020
1 ,.
;:
i
Y: