1261------�;—--------------------------------------
NOTE:'
------------------------------------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: October 24, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION —52980 Obregon, La Quints.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach. Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
i Riverside County Std. ,#207
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST,, 1,500.00
(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 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 App 4cant or Agent
Harry White 500 E. Amado Rd. Palm Spring, CA 92262 (619) 322-5271
Name of Applicant (please print) Business Address Telephone No.
Jess Garcia Concrete 82-358 Mountain View Indio, CA 92201 (619) 347-8919
Name of Contractor and Job Foreman Business Address Telephone No.
618704 New pending
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
10
FEES: Subdivision Improvement Permit — Class I I I S s 1 AL 1 ` 30:00
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00
Permit Fee 10.00
`t,Penalty
Cash Deposit -Surety Bond
if required t.
TOTAL: $ 30.00
Receipt No.
Received by Date
i
Recorded by
n '� 1
1261
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED f0 Zy— 91
EXPIRATION DATE
DATE ISSUED .2 91
By
Administrative Authority
TELEPHONE: (619) 564-2246
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
w
/ Subdivision Improvement Permit — Class II I
DgTE: 2 �l Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION - 4a2 n 0iL,o �, �; Jim 'ry,74---
v
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION �y Agiptzo;4Clt f"
Sketch (attach construction plans if appropriate)
�d
DESCRIPTION OF CONSTRUCTION 4f/- Com"~ (���4 � D- 15
a� cY,lo —
DIMENSION OF INSTALLATION OR REMOVAL
S-4evctj Speei- >ve-
w�Y
SIZE OF EXCAVATION, IF NEEDED L
APPROXIMATE TIME WHEN WORK WILL BEGIN Dr 5761
ww�"APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ d
(Including removal of all obstruction, materials, a4 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 Applica or Agent
Name of Appli ant (please print) Business Address vi CA Telephone No.
5 Z- 3 S7e5 r�� di�� 3 7-8 �tl
Name of Contractor and Job Foreman Business Address Tele hone No.
- 6,19701-
Contractor's License 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 $ d
Permit Fee ) O , U 1
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 3o r 0C>
Received by Date
Recorded by
1236
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564.2246
Administrative Authority