1271Wi�h'pr.'oper'validation
this form constitutes an
encroachment permit
a
21111111160
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 30, 1991 Subdivision Improvement Permit— Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-592 Ave. Obregon
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION constructing driveway and Sketch .(attach construction plans if appropriate)
approach
DESCRIPTION OF CONSTRUCTION- See attached Riverside County Std. 207.
DIMENSION OF INSTALLATION OR REMOVAL
,SIZE OF EXCAVATION, IF NEEDED
'. APPROXIMATE. TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $i
(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 ouinta and to pay, for'any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
Kenyon and Brad Jones 79-738 Arnold Palmer Dr. La Quints, CA 92253 771-0511
Name of Applicant .(please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address r: Telephone No. "
Owner builder r
Contractor's License No. City Business License No.
Applicant's Insurance Company PolicyAil8ff 10 5338 10-30-81 10
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
$ 20.00
10.00
$ 30.00
Received by Date
Recordedby
tr'
1271,
PERMIT VALIDATION
PERMIT NO. �a 7 "�
DATE APPROVED '-70 3�G
EXPIRATION DATE _/_/ _ r
DAT ISUED to -30— 1)
By
Administrative Authority
TELEPHONE: (619) 564-2246
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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 I II
DATE: is 30 9 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION - 24 5"111 AYe- nb�,oi ,
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION 40, lilluEtiA L�Ywew,y
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
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:
Sketch (attach construction plans if appropriate)
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 ea .raw a 1�rtd Jowes `IQ -l3$ A—,*,d, Pc —CIV, D, La 0-,'4t- (x,91
Name of Applicant (please print) Business Address Telephone No.
Name off�Contractor
tt��and `Job Foreman Business Address Telephone No.
V ww2v — R. Fd"
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
1236
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564.2246
Administrative Authority
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