1273NOTE:.
With propervalidation
this form constitutes an
encroachment permit
0"
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 II I
DATE: October 31. 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Driveway agproach at 54-220 Obregon, La Quints
(Street address or Description of Location).
PURPOSE OF CONSTRUCTION Concrete approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
T SEE ATTACHED RIVERSIDE COUNTY'STD. 207..,
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 11/1/91
APPROXIMATE TIME OF COMPLETION -11/1/91
ESTIMATED CONSTRUCTION COST $ 300.00
(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.
f
Signature of Applicant or Agent
William Riley. Box 2121 Palm Desert, CA 92260 564-4977
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
r
—.;i _91 i0
FEES: Subdivision Improvement Permit — Class.I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1 273...
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00 PERMIT VALIDATION
10.00
Permit FeePERMIT NO. 1273
Penalty DATE APPROVED 10/31/91
Cash Deposit -Surety Bond
if required EXPIRATION DATE "11/5/91
TOTAL: $ 30.00 DATE IS E, 10/31/91
Receipt No.
BY
Received by Date Administrative Authority
Recorded by t;;, .:, TELEPHONE: (619) 564-2246
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 I I I
DgTE: VV,311q V,311Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S4� 2 Z..e C,6& 011(j,
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Ao&/K L4 AO&eC-11 Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION C dliZat& dmac#{ -
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN II%ea A/H
APPROXIMATE' TIME OF COMPLETION Nov
ESTIMATED CONSTRUCTION COST $ 1011
(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 gent
4/— 4eV -7 7
Name of Applicant (please print) Business Address Telephone No.
Gwlv-lr2
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
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
Recorded by
1236
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564.2246
Administrative Authority