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1250i .r . NOS°f With"'proper validation this form constitutes an encroachment permit iCITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) ff 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 11, 1991 LOCATION OF CONSTRUCTION 53-760 Avenida Madero (Street address or Description of Location) . O PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION Retro—fit approach and curb cut DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 10/14/91 Subdivision Improvement Permit — Class I II Minor Improvement Permit Class IV Sketch (attach construction plans if appropriate) Driveway approach shall be constructed per Riverside County STD 4207 APPROXIMATE TIME OF COMPLETION 10/28/91 ESTIMATED CONSTRUCTION COST $ 509.00 (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: 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. Signature of.Applicant or Agent y Michael L. Bangerter P.O. Box 59 La Quints`, --92253 564-1486 Name of Applicant (please print) Business Address Telephone No. General Contract MaSement P.O. Box 59 La Quints, CA 92253 56401486 Name of Contractor and Job Foreman Business Address Telephone No. 524-325 1235 Contractor's License No. City Business License No. Advanced Insurance Service, Inc. LEAGL020488 Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class III1�(j51g�sI11, 4924AL'01 ii_N.00 i0 — Public improvements: 3% of estimated construction costs C i 1f3T 3 Private improvements: 3% of estimated construction costs 1250 Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ 20.00 II Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by Recorded by 10.00 J $ 30.00 Date PERMIT NO PERMIT VALIDATION 1250 DATE APPROVED 10/11/91 EXPIRATION DATE 10/28/91 DATE ISSUED By 18/11/01 TELEPHONE: (619) 564-2246 Administrative Authority L s �:. .� ED 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 D&TE:� Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION S3 ? s - IWA-Q,atez:�) (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION % G Sketch (attach construction plans if appropriate) ,DiZkvF,WA -5 WALL. DIMENSION OF INSTALLATION OR REMOVAL ��J�25lpi� SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN ,1�� >a—✓`/-9� APPROXIMATE TIME OF COMPLETION - ics / ESTIMATED CONSTRUCTION COST $ S30 (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: � w> "5-r(> •a� 2z-7 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 Le Ouinta and to pay for any additional replacement necessary as the result of this work. Signatur licar or A nt _AN't Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business License No. ,moi/A�G�1 �,�� �.-c.0 • � z�i �-� �.�-e Z �- A- Gi L oz.s � �8' 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 r 1.236 Minor Improvement Permit - Class IV: See attached schedule --7© Inspection Fee $ PERMIT VALIDATION Permit Fee ��.r t'�'Y,.J1:7 iSTjs�..V,-'i.`':�'/Nf♦ :•.i.Y .C,t_tti PERMIT�:NO" �.�. :�-*.�--s',..,_ ...�•, _-t» r^... �` ^'2 Penalty Cash Deposit Surety Bond " t DATE APPROVED` t if required - EXPIRATION �$. ,�.,y ,, ?,b'* ��.;,_ �-`I'#r;..�� s,. DATE �.:;.�::;j=.r��Rs�+<�tF'�s :'a,r. :,,,+r �, TOTAL: •; •;,F• _ DATE ISSUED Receipt No.:(}r',i y,•,i:!�'a�:tf�'{I•t^� �Dat-e Received by T` Administrative Authority- �•, t- = .�•{ J ,. i. �} • �i :r 7•t!{��.� � � . . f ^�.i, Recorded by, .. a � r a y;�l� ' TEL'EP>HONE..(619) 564-2246a • � • xs F ,�•+ ,• :J' of NOTE: With proper validation this form constitutes an encroachment permit CITY OF LA QUINTA 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 111 DATE: October 11, 1991 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 53-760 Avenida Madero (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION' Retro—fit approach and curb cut DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 10/14/91 APPROXIMATE TIME OF COMPLETION 10/28/91 ESTIMATED CONSTRUCTION COST $ 509.00 -' ('Including removal of all cbstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) Sketch (attach construction plans if appropriate) Driveway approach shall be constructed per Riverside County STD 11207 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. Signaturephcant or Agent Michael L. Bangerter P.O. Box 59 La Quinta, C 564-1486 Name of Applicant (please print) Business Address Telephone No. General Contract Magement P.O. Box 59 La Quinta, CA 92253 564=1486 Name of Contractor and Job Foreman Business Address Telephone No. 524-325 1235 Contractor's License No. City Business License No. Advanced Insurance Service, Inc. LEAGL020488 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. $ 20.00 10.00 $ 30.00 Received by , Date Recorded by S0051p&iQ? AL0 11-9 0.00 10 12J0 PERMIT VALIDATION PERMIT NO. 1250 DATE APPROVED 10/11/91 EXPIRATION DATE 10/28/91 DATE ISSUED 10/11/91 By Administrative Authority TELEPHONE: (619) 564.2246