1242----- t:.�*.r�--------------------------------------------------------------------•-----------------
NOTE:'_ °
With proper validation 4 2
0
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
DATE: 10/3/91
LOCATION OF CONSTRUCTION 53-845 Valle¢op La Quints.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Driveway
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
r
SIZE OF EXCAVATION, IF NEEDED
-.,
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ -210- Remeval of curb
11
(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. $207, attached.
i005i8l SH0141OT41 0103-90,00 14
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 per it and all applicable rul and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result this work
Signature of Applicant or Agent ;.
David n Fisher 53-650 Ave Diaz (619) 564-2539
Name of Applicant (please print) Business Address Telephone No.
David D. Fisher Construction Same Same
Name of Contractor and Job Foreman Business Address Telephone No
334932 0227
Contractor's License No. City Business License No.
Workmans Comp. Transamerica 28 WCG8056064B
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 $
Zo , 00
Permit Fee
10,00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
?j0 � 0 0
Receipt No.
Received by
Date
Recorded by
1242
PERMIT VALIDATION
PERMIT NO. 1242
DATE APPROVED �D — 3 - Ot
EXPIRATION DATE +10
DATE ISSU D
By
Administrative Authority
TELEPHONE: (619) 564-2246
,IN
-oI
__-----
---- ------------------------------------------------------------------------------------
r
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 Minor Improve ,e�Int Permit Class IV
LOCATION OF CONSTRUCTION �� ���� / A >�y 7, 4;�YY;rT�
(Street address or Description of Location)/
PURPOSE OF CONSTRUCTION LejSketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
) \vFwa 1 ,ApfR0ACl7+ s0 -n LL
UL CC, QS72vt (i7
DIMENSION OF INSTALLATION OR REMOVAL Zvi.Iv2S I PC, C�k,0_1�
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
lj Z'p Z o %
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 4.10 ZEW,-
(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 t e time when work will/6e started:
Comply with all applicable City Ordinances, the terms and conditions of the it nd all applicable s a regulations of the City of
La Ouinta and to pay for any additional replacement necessary as the result of th' ork.
Name Vf Applicant (please print)
Name of Contractor and Job Foreman
Signature of.Applicant or
' -&SO P-ug;9:', JJ/41,Z
Bus�pess Address Telephone No.
Business Address
Telephone No.
t
S34�/�'I
Contractor's Li7VeLA10Wf
o. City Business License No.
LmP cyw & D 06519
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 $ -- 00
Permit Fee I n 0 `..
Penalty �� 1
Cash Deposit -Surety Bond
if required
TOTAL: $- 0�
Receipt No.
Received by
Recorded by
Date
1236
PERMIT VALIDATION
PERMIT NO. JZ yz µ
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an CITY OF LA OUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OF
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit - Class II I
DATE: 10/3/91 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION _53-845 Vallejo -n La Quinta
(Street address or Description of Location) -
PURPOSE OF CONSTRUCTION Driveway Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION Driveway approach shall be
constructed per Riverside
DIMENSION OF INSTALLATION OR REMOVAL County Std. #207, attached.
SIZE OF EXCAVATION, IRNEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 1g051�5A014jdjAL10103-9 30.00 14
ESTIMATED CONSTRUCTIONCOST$ 71Q,Rpmnval of rnrlh
(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, hafmless 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 pe t nd all applicable ruI a regulations of the City of
La Quinta and to pay for any additional replacement necessary, as the result t s
� c
Signature of Applicant or Agent
David n. Fisher 53-650 Avg nin7 (61 Q) 5614-9599
Name of Applicant (please print) Business Address Telephone No.
David D. Fisher Construction Same Same
Name of Contractor and Job Foreman Business Address Telephone No.
334932 0127
Contractor's License No. City Business License No.
Workmans Comp. Transamerica 28 WCG8056064B
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 $ ZO , DO
Permit Fee 10,0(1
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
Received by
Recorded by
$ 3O, 00
Date
1242
PERMIT VALIDATION ,
PERMIT NO. 1242
DATE APPROVED �� - 3 ^ Ot
EXPIRATION DATE
DATE ISSUED
By. -
Administrative Authority
TELEPHONE: (619) 564.2246