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1252NOSE: 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: October 11, 1991 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION — S 3 ' / Gy QV 2 C 90—CN,A13 ZaA (Street address or Description of Location) PURPOSE OF CONSTRUCTION �DESCRIPTION OF CONSTRUCTION Retro—fit approach and curb cut DI-MENSION OF INSTALLATION OR REMOVAL SIZ&OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 10/14/91 Sketch (attach construction plans if appropriate) APPROXIMATE TIME OF COMPLETION 10/28/91 ESTIMATED CONSTRUCTION COST $ 500.00 (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: Driveway, approach shall be constructed per Riverside County STD 0207 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. Sfgnatture_of Applicant or Agent Michael L. Bangerter P.O. Box 59 La Quinta, CA 92253 564-1456 Name of Applicant (please print) Business Address Telephone No. General Contract Management Same Same Same Name of Contractor and Job Foreman Business Address Telephone No. On File On File Contractor's License No. City Business License No. On File On File Applicant's Insurance Company Policy Number �05182 C�SH 01 "M AL i i i r 0.4'0 f 0 FEES: Subdivision Improvement Permit —Class III S 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 20.00 10.00 $ 30.00 Receipt No. Received by Date Recorded by ;i 1252 1*3 PERMIT VALIDATION PERMIT NO. 1'252 DATE APPROVED 10/11/91. EXPIRATION DATE 10/28/91 DATE ISSUED 10/11/91 By - i Administrative Authority TELEPHONE: (619) 564-2246 i1 I NOTE: 4 With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit S APPLICATION FOR PERMIT � PUBLIC. WORKS CONSTRUCTION (ENCROACHMENT) C� OFTI���s`c 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 I DATE: October 11 1991 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 4 (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 Sketch (attach construction plans if appropriate) Driveway approach shall be constructed per Riverside County STD 11207 APPROXIMATE TIME WHEN WORK WILL BEGIN 10 14 91 APPROXIMATE TIME OF COMPLETION 10/28/91 ESTIMATED CONSTRUCTION COST $ 500.00 (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 andsave 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. A licant or Agent Michael L. Bangerter P.O. Box 59 La Quinta, CA 92253 564-1456 Name of Applicant (please print) Business Address Telephone No. General Contract Management Same Same Same Name of Contractor and Job Foreman Business Address Telephone No. On File On File CCity Business License No. Contractor's License No. On File On File Applicant's Insurance Company Policy Number i 40510@�S�Oi AL i 0.00 SO FEES: Subdivision Improvemerlt Permit —Class I I I 0 Public improvements: 3% of estimated construction costs 12 J 2 Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ 20.00 II PERMIT VALIDATION PERMIT NO. Permit Fee 10.00 1252 Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by Recorded by $ 30.00 Date DATE APPROVED 10/11/91 EXPIRATION DATE 10/28/91 DATE ISSUED 10/11/91 By TELEPHONE: (619) 564.2246 Administrative Authority ------=� ------------------------- - ------------------- r� 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 DgTE: �� 7�-G%� Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 4-3-14-L:2 ASG �.H-c 2 Z•4 (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION s - - DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN &=&r 4211 APPROXIMATE TIME OF COMPLETION l�rr�o�ZG1� ESTIMATED CONSTRUCTION COST $ —�'� (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing, and/or replacing improvements) Sketch (attach construction plans if appropriate) DRI v iaJf1 y Aq R_0 AC_U �► ��— 6e Co►JS--Ce A TU -0 fw 2 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. -C 1 Signature of Applican lti!rcfi�►&( /- 'Pa 5-9 S651-/Vs�c Name of Applicant (please print) Business Address Telephone No. /500 .6 - Name of Contractor and Job Foreman Business Address Telephone No. - 'x/_ 3 ZS Contractor's License No. /7.35, City Business License No. ev cry` 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 123E PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE -ISSUED (o r By Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246'