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NOTE-'—
'With
OTE-''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
September 12, 1991 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-925 Avenida Diaz
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION For driveway
DESCRIPTION OF CONSTRUCTION Driveway Approach
DIMENSION OF INSTALLATION OR REMOVAL 6' x 20'
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1.wk 9/16/91
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 2 wk 9/27/91
ESTIMATED CONSTRUCTION COST $ $300
(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:
Driveway Approach shall be
constructed per Riverside County
Std No. 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) ho s in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and condition f the pft
t and all applicable rules and regulatio s of the City of
La Quinta and to pay for any additional replacement necessary as the ult oi�w rk.
r!/_ r J
�
Signature f Applicant or Agent
David Ross Miller Box 722 La Quint 564-5823
Name of Applicant (please print) Business Address Telephone No.
Pacific Trades (David Miller) Box 722 La Quinta 564-5823
Name of Contractor and Job Foreman Business Address Telephone No.
B425881 1955
Contractor's License No. City Business License No.
Farmers Insurance 90956 93 55
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 Tee $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
a
i 0 45VR.S�H 0,, 4? AL091 12-9 30.04 i 0
PERMIT VALIDATION
PERMIT NO. 1208
DATE APPROVED 9/12/91
EXPIRATION DATE 9/27/91
DATE ISS -ED 9/12/91
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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T
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 -
GG Subdivision Improvement Permit — Class III
DATE:— _ -4 1Z1� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S3- �ZS ' �I 4q
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 622 Ckiyf)A-V Sketch (attach construction plans if appropriate)'
DESCRIPTION OF CONSTRUCTION nA - ��►,� a- RT ��c.t1 pytvFW/gq
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Apa, Ac,N
Go tJ S (Lu c_TL�iJ;-*)
S`tc) 6lo Z0-7
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
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 Dregulations
Comply with all applicable City Ordinances, the terms and con 'ons of the permit and all applicable rulthe City of
La Quinta and to pay for any additional replacement necessary a 't esu
lt o k.
Signature ofpplicant or Agent
JAI o ROSS K kola, -Va �zz L.a? S:64 S9z.7-S
Name of Applicant (please print) Business Address Telephone No'
Fac, Tnkk.; laoi►K (t4.tL) �3-LxrT72,7, L. 5%q-5
Na a of Contractor and Job Foreman Business Address Telephone No.
.��qj9S5
Contractor's License No. City Business License No.
f� s �io956 9 g�S
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs 1 2 01 6
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule,
Inspection Fee $ ' Z -O O v
Permit Fee to Dv
Penalty '
Cash Deposit -Surety Bond.
if required
TOTAL
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1zo�
DATE APPROVED �Z OL
EXPIRATION DATE . 'Q / Z711- 41
DATE ISSUED I 9• t2— ct I
By
TELEPHONE: (619) 564-2246
Administrative Authority
a
NOTE:
With proper validation ;
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT j
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)C
OF�ti i
i
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: September 12, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-925 Avenida Diaz
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION For driveway
DESCRIPTION OF CONSTRUCTION Driveway Approach
DIMENSION OF INSTALLATION OR REMOVAL 61 x 201
Sketch (attach construction plans if appropriate)
Driveway Approach shall be
constructed per Riverside County
Std No. 207 (Attached)
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1 wk 9/16/91
APPROXIMATE TIME OF COMPLETION 2 wk 9/27/91
ESTIMATED CONSTRUCTION COST $ - $300
(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) has,e
in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and cond^ f the` r it d all applicable rules and-rntratreas` of the City of
La Quints and to pay for any additional replacement necessary r ult o t w k. \1
r J
Signature kf Applicant or Agent
David Ross Miller Box 722 La Quint 564-5823
rvame OT Applicant (please print) business Address Telephone No.
Pacific Trades (David Miller) Box 722 La Quinta 564-5823
Name of Contractor and Job Foreman Business Address Telephone No.
B425381 1955
Contractor's License No. City Business License No.
Farmers Insurance 90956 9355
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs 1�051� H� ,1
L091 12-9130.00 SO
Private improvements: 3% of estimated construction costs U `
Minor Improvement Permit - Class IV: See attached schedule
Inspection Fee $ 20.00 I PERMIT VALIDATION
Permit Fee 10.00
2
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 30.00
Date
PERMIT NO. 1 OS
DATE APPROVED 9/12/91
EXPIRATION DATE 9/27/91
DATE ISS ED 9/1,2/91
By
Administrative Authority
TELEPHONE: (619) 564.2246
i