1215NOTE:
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: 9-18-91 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 47-355 VIA KORON
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION DRIVEWAY 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)
DRIVEWAY APPROACH SHALL BE
CONSTRUCTED PER RIV. CO. STD. 1PI
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 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.
Signature of Appli r V t
WILMA BBCIFIC 2801 TOWNSGATE RD STE 211 805— 495-5010
Name of Applicant (please print) Business Address Telephone No.
__WPRtlake village ca 91361
Name of Contractor and Job Foreman Business Address Telephone No.
453787 1730
Contractor's License No.
USFG
City0 jVg gjs4�igepse No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
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
Permit Fee 10
Penalty
Cash Deposit -Surety Bond
if,required
TOTAL
Receipt No.
$0.
Received by Date
Recorded by
I1t
005182�Oi44T�3AL41 _i8_93 0,00 10
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE )10-31-91
DATE I SUED - 9
By
dministrative Authority
TELEPHONE: (619) $,64-2246
I
0021
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 III
DATE: / J rr// Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION — G %/ % C. .yz -, S�S� /-",V %o /1 AJ
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION 1Jr'- .; i
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
'QJL�.\o Py AWI-0Ac
cmfssTQNc- �O PIP-
,
lf�vfv0590ff— G
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 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.
Signature of App 'c t or _
i
715
Name of Applicant (please print) Esiness Aacress 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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
?.,/ 5 -
PERMIT
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authority