1247M4
NOTE:
With proper validation 2
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
October 9, 1991 Subdivision Improvement Permit — Class I II
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54045 Ramirez
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway piaroach
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)
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:
Driveway approach shall be
constructed per Riverside.
County Std. #207, attached
1�0Sii9�SH014?&TALO-3
09-9 4.00 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 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. n
Name of Applicant (please print) '
Signafdfe of Applicant ok Agent k
Business
Telephone No.
248823
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 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 $ 10,670
Permit Fee 10,067
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
$
Receipt No.
Received by Date
Recorded by
PERMIT NO.
PERMIT VALIDATION
1247
124T 'y
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By— _73a�_ _AZ4171�
A ministrative Authority
TELEPHONE: (619) 564-2246
i
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: 10 -43 -'%1 Minor Improvement Permit Class IV,
LOCATION OF CONSTRUCTION S11 o 4 s
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION D1125, 16-2441 4-P10Ao4-"I
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)
PVeWPY Aff2DAcw S�-AI--
t3� f ire
Af TA cOV�a
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.
of Applicant or
Names of Applicant (please print) Business Address Telephone No.
(i- S41--0,0-- 1-1V Q (l l lot e . /e cz, iL 6-T 3, y o /3(.1
Name of Contractor and Job Foreman Business Address Telephone No.
214 8 8L3
Contractor's License No.
x
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 _.
1236
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authority