1307� � R
iVOf E:
• With,proper validation,
l �w�s his'form constitutes an
encroachment permit CITY OF LA QUINTA
' APPLICATION FOR PERMIT i$
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) "n' 4�
OF
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
December 9,",,,1991 Subdivision Improvement Permit —'Class I II
t
,-DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION' 54-595 Velasco- La Ouinta, CA 92253
'
(Street address or Description of Location) ! +'
t Driveway approach
' PURPOSE OF CONSTRUCTION Sketch (attach construction`plans if appropriate)
DESCRIPTION OF CONSTRUCTION' DrivewAq approach shall be
constructed per Riverside
DIMENSION OF INSTALLATION OR REMOVAL eet
County Std. No.,207, attached.
�• • T i I.
SIZE OF EXCAVATION, IF NEEDED -
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION ti
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) '
r -
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 oroccurring 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 pe and all icable r les and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the resu his wor .
i_ •
ignature of App nt or Agen
Majectic Home P.O. Box 76 La Quint , CA 92253 568-6014 `
Name of Applicant (please print) Business Address Telephone No.
'William R. Rogers 67720 Peinetta Cathedral City, CA 322-8083
Name of Contractor and Job Foreman Business Address Telephone No.
291728
Contractor's License No. City Business License No.
Applicarit's Insurance Company ` , . Policy Number
FEES: -Subdivision Improvement Per = Class I II 05182 0 S q 12"09-9 ho l
Y ifs L��iSH 1 T�TAL i 30.00 f.. -
Public improvements: 3% of estimated construction costs
{, Private improvements: 3% of estimated construction costs ` 13-07 r
Minor Improvement Permit — Class IV: See attached schedule '
• 20.
Inspection Fee $ 00' PERMIT VALIDATION '
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
30.00
f Received by Date
Recorded by
PERMIT NO. 13071 ,
DATE APPROVED 12/9/91
EXPIRATION DATE 12/20/91
DATE ISSUE 12/9/91
By
dministrative 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
Subdivision Improvement Permit — Class 111
DgTE:_ ��— �� %� Minor ImprovementPermitClass IV
LOCATION OF CONSTRUCTION �__ 9S Vell,� S G U f ui,y�i� C,�/ � �5 3
_?
(Street address or Description of Location) ,
PURPOSE OF CONSTRUCTION �j0n1*,rjQ PA ',I yj Ay
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL AQ
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
DA 4-f (Ai 197 pYrnowch 5AJQI/ b e
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:
CoIidnu,14. PCS. R,,Jc,cr; Je.
Gw"jt7 ` s 7;b Ad 0,67
N -i Actid
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 perm* And all applicable rules and regulations of the City of
La Quints and to pay for any additional replacement necessary as the result of is work.
gnature of App nt or Age
gaz o m c. � � i3o,r 7G /1,2av',� Ky 17 50 K0, / Y
of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job F6reman Business Address Telephone No.
C/F59
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 $ II
Permit Fee 8 a
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ '30-vo
Received by _Date
Recorded by
123.6
PERMIT VALIDATION
PERMIT NO. J307
DATE APPROVED ) Z — 9 V 9
EXPIRATION DATE 1 2 — Z0 _ R
DATE ISSUED -- 12,— a—°l1
By
TELEPHONE: (619) 564.2246
Administrative Authority