1293Wit}.proper validation
this`form constitutes an
encroachment permit
f
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 connectionfvvith MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
/ 16
November 21, 1991 Subdivision Improvement Permit — Class I I I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-470 Martinez
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driyeyay apAroadh Sketch (attach construction plans if appropriate)
,
DESCRIPTION OF CONSTRUCTION Per Riverside County Std. No. 207,
attached.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
ti
APPROXIMATE TIME WHEN WORK WILL BEGIN 11/21/91
APPROXIMATE TIME OF COMPLETION 11/21/91
ESTIMATED CONSTRUCTION COST $ 1.75.000)
(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 avid 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. i
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
i
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulatlons of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Sig
Rock Cir. Palm Desert, CA
Name of Applicant (please print)
Business Address
or Agent
346-4020
Telephone
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 i
FEES: Subdivision Improvement Permit — Class III 1�O50i4015'�0 ALi1 2i-� 34.00 i0
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1293
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00
10.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by
Recorded by
Date
PERMIT VALIDATION
PERMIT NO. 1293
DATE APPROVED 11/21/91
EXPIRATION DATE 11./2.9/91
DATE ISSUED 11/21/91
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
D9TE
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit - Class III
Minor Improvement Permit Class IV
3 — q 7 0 Al 14 47-1,
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION PEI VF- &0PY
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Z
Sketch (attach construction plans if appropriate)
Q�(L
t?) V r& R -S I D r.
Co u ,v 7 / —j -r .D ;V- 00%
•_rTu
RVW
�a
APPROXIMATE TIME WHEN WORK WILL BEGIN I ' 2
-` APPROXIMATE TIME OF COMPLETION -,:2 / G
ESTIMATED CONSTRUCTION COST $ --� i S
(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 :his 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.
1
/ Si ture of Applicant or Agent
Name of Applicant (please print) Business Address Telephone No.
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 $ 2-10 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
)0
$ 30
Date
1236
PERMIT VALIDATION
PERMIT NO. /�93
DATE APPROVED
EXPIRATION DATE ZL 2 '7
DATE ISSUED
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564.2246