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1219f" 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 II I DATE: September 18, 1991 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Lot 197 47-350 Via Koron (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Driveway Approach Driveway approach shall be constructed per Riverside County Std. No. 207 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, loss or damage to persons or propefty 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 A pli t o Agent Wilma Pacific, 2801 Townsgate Road, Suite 211, Westlake Village, CA 91361 (805)-495-5010 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. 453787 1730 Contractor's License No. City Business License No. U.S.F.G. 0208914897 Applicant's. Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class I II 180S1132S4014�&�091 i8-9 30. U© i0 Public improvements: 3% of estimated construction costs �^ j Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ 20.00 Permit Fee 10.00 Penalty Cash Deposit -Surety Bond if required TOTAL: $ 30.00 Receipt No. Received by Recorded by Date PERMIT VALIDATION - PERMIT NO. 1219 DATE APPROVED 9/18/91 EXPIRATION DATE 10/31/91 DATE ISS E 9/18/91 By Administrative Authority TELEPHONE: (619) 564-2246 .._.z _ ._ , ..._ �._ ., �� �.:. ;t I �4 'Ike 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: 9 i/ �! f/ Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION frl Ci % % g "1 b-0- r, 0 /C—D /(DC7 /✓ (Street address or Description of Location) PURPOSE OF CONSTRUCTION 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) Appa,04v14 }{�►YL Pa� ?ro7 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. ignature of Applic r Ag _l � .1, O —Oc i2 �t,2,1>?1'��� �- � J / % Name of Applicant (please print)usi� ness Aodress 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 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By TELEPHONE: (619) 564.2246 Administrative Authority