1290NOTE:
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
DATE: November 19, 1991
LOCATION OF CONSTRUCTION 53-880 Ramirez
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach
DESCRIPTION OF CONSTRUCTION Driveway approach
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 11/21/91
ESTIMATED CONSTRUCTION COST $ 266.00
(Including removal of all obstruction, materials, and debris, backfilling, com-
Subdivision Improvement Permit - Class II I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Per Rivorsido County Std. No. 207,
attached•
A
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.
6-9
Signature of Applicant or Agent
Werner Boettcher 82365 Hwy. 111 #S Iadio, CA 564-3911
Name of Applicant (please print) Business Address Telephone No.
Same OWNER BUILDER . W
Name of Contractor and Job Foreman Business Address Telephone No.
366385
Contractor's License No. City Business License No.
American States
Applicant's Insurance Company Policy Number
00 ;I 1_ ., 1 10
FEES: Subdivision Improvement Permit - Class III 10 AS 1 TAL 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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
1290
PERMIT VALIDATION
PERMIT NO. - 1290
DATE APPROVED 11/19/91
EXPIRATION -DATE 11/22/91
DATE ISSUED / 11/19/91
ByS
A8-m-iMrrative Authority
TELEPHONE: (619) 564-2246
77 Y
-..-,--a_"-
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
DATE:_ I — C11 n Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S 3 ?kO iZct w„ I- V -2
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION c- 4 w C, 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
APPROXIMATE TIME OF COMPLETION PI0
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.
Signature of Applicant or Agent
P<—
Name of Applicant (please print) Business Address Telephone No.
501 C4, e �5 2 30:— �l� �, /// S ,1 hc�� c, S Y- 3?11
Name of Contractor and Job Foreman Business Address Telephone No.
- � 6O Z S—
Contractor's License No.ff City Business License No.
Vl- evr c A !- 1, gT��
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 39/6 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
Date
12.36
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authority