1220NOTE:
. With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA -
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) "
V
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 I I
DATE: September 18, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Lot 198 47-320 Via Koron
(Street address or Description of Location)
v�.
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Driveway ARRroach 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 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.
ailma Pacific, 2801 Tows
Name of Applicant (please print)
S a r of Appl
e Road, Suite 211, Westlake V�
Business Address
CA 91361 (805) 495-5010
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
453787 1730
Contractor's License No. City Business License No.
U.S.B.G. 0208914897
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
$ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
i4005iC�SH014TO4T1 09i i8-9 30.00.. 10
12 1 C_ �
PERMIT VALIDATION
PERMIT NO. 1220
DATE APPROVED 9/18/91
EXPIRATION DATE 10/31/91
DATE ISSUED -9/18/ 1
By
Administrative Authority
TELEPHONE: (619) 564-2246
_y
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: / ! Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION — ,�D % .19P
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION �r 4'� %i .r i
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
i12 r d� 7 7
Dry 1pit rJZ� 5 Ltd { Z f,
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.
r
Signature ofp can Agent
.�� �a� �'/=-' � • '1,1'0 / To���,���r�r�� E- .� iJ - �a.�'• '� 9�`-� �/�
�J �u iTe
Name of Applicant (please print) usiness Aadress 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
Administrative Authority
TELEPHONE: (619) 564-2246