1253�.,-�..•,,.*-.rte-.,...r...
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NOTE:
With proper validation QUI
this form constitutes an FR'
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 I II
DATE: October 14, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-245 Carranza
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Curb Saw for driveway Sketch (attach construction plans if appropriate)
approach
DESCRIPTION OF CONSTRUCTION 30' of curb removal Driveway approach shall be' constructed
per Riverside County Std 4207
(aetached)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 10/15/91
APPROXIMATE TIME OF COMPLETION 10/19/91
ESTIMATED CONSTRUCTION COST $ . 1.000
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Inconsideration 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. r
Comply with all applicable City Ordinances, the terms and conditions of th permit and all applicable rules and reg lation of the City of
La Quinta and to pay for any additional replacement necessary as the resulpf this work.-
\u� C
Sig
James A. Stone 38-152 Rock Circle
of Applicant or Agent
.Palm Desert, CA 92260 346-4020
Name of Applicant (please print) Business Address • Telephone No.
Owner/Builder ,
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 III pOS1 1 0 4 10-i4-9 10
1(� LRSH i TOTAL 1 30.00
Public improvements: 3% of estimated construction costs .y
Private improvements: 3% of estimated construction costs 1 253
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00 II
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
'Received by Date
Recorded by
r t}
s
PERMIT VALIDATION
PERMIT NO. 1253
DATE APPROVED 10/14/91.
EXPIRATION DATE 10/25/91
DATE ISUED 10/14/91
,
By
Administrative Authority.
TELEPHONE: (619) 564-2246
1
1
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
D&TE: C/ T l _ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOS F CONSTR CTION
DESCRIPTION OFC OgSTPUCTIAN %
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILLA � N
/� _ / C ._
Sketch (attach construction plans if appropriate)
�Z� ✓ X25 �Oc� Co w..i� S7� � Z•�7
c-
7.4 t--k-A)
APPROXIMATE TIME OF COMPLETION —/Z—
ESTIMATED
—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. i
Name df Contractor and Job Foreman
Contractor's License No.
Business Address
Business Address
Telephone No.
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
$ /0
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
,w , ,-3 i7
`..' -
Date
I 1236
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative. Authority
TELEPHONE:: (619) 564=2246;::
I