1243NOTE:
With proper validation 2
O
this form constitutes an CITY OF LA QUINTA
encroachment permit
,APPLICATION FOR PERMIT I
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: October 3, 1991
LOCATION OF CONSTRUCTION 54-530 Diaz Avenue
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION driveway annrnarh Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Per Riverside County Std. 4207.
DIMENSION OF INSTALLATION OR REMOVAL 20 feet
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 10/3/91
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 30.00
(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: `"`"+��•-xX...
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.
Ctistobal C. Arroyo 45—
Name of'Applicant (please print)
Signature of Applicant,6r Agent
Business Address
11 a
Tel
/JH/—
ne No.
PBA Construction Same Same
Name of Contractor and Job Foreman Business Address Telephone No.
`547897146 T
9
Contractor's License No. City Business. License No.
+ AFCO GLS320052
Applicant's Insurance Company Policy Number . w
FEES: Subdivision Improvement Permit — Class I I I ,
Public improvements:. 3% of estimated construction costs qQS g i0 4i0_.Q �'3
Private improvements: 3% of estimated construction costs is ;CSW i i$p)- it,�3 �i.00
Minor Improvement Permit — Class IV: See attached schedule,=
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Inspection Fee $ ,!� PERMIT VALIDATION
Permit Fee ; tq • DD
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $QQ
Receipt No,
Received by
Recorded by
Date
I
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PERMIT NO. 12433
'
DATE APPROVED
ll
EXPIRATION DATE
.]0/1B/qj
DATE ISSUED
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By
Administrative Authority
TELEPHONE: (619) 564-2246
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NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit v
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
C� 0
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: October 3, 1991
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-530 Diaz Avenue.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION driveway aRnrnae-h
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 90 fPPf
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 10/1/91
Sketch (attach construction plans if appropriate)
Per Riverside County Std. #207.
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ MUM
(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:
I
indemnify, -defend and gave 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 end regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
/ i
Signature of gpplicant,6r Agent
Name of Applicant (please print) Business Address Telep one No.
PBA Construction_ came Same
Name of Contractor and Job Foreman Business Address Telephone No.
547897 1469.
Contractor's License No. City Business License No.
AFCO
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs TOT
Private improvements: 3% of estimated construction costs i 0051R�S0i4 d ALOi ,00
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00 PERMIT VALIDATION
Permit Fee /0. 00 PERMIT NO.
Penalty _
Cash Deposit -Surety Bond .
if required
TOTAL:
Receipt No.
Received by Date
Recorded by
DATE APPROVED
EXPIRATION DATE
DATE SSUED 0 — 1
By
Administrative Authority
TELEPHONE: (619) 564.2246
-