1320,.'Nf�T,Ec.. �, I u
Vl�th pro er validation ,
w_thii,46rm,constitutes an
4
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
`December 31, 1991 Subdivision Improvement Permit— Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 46290 Cameo Palms Drive La Quinta, CA 92253
(Street address or Description, of Location), M • Y} _ f
PURPOSE OF CONSTRUCTION . Bring driveway/approach Sketch (attach constructionlans if a
to code. P appropriate)
DESCRIPTION OF CONSTRUCTION Removal of existing
driveway/approach and replacement. See attached Riverside County
DIMENSION OF INSTALLATION OR REMOVAL • 40 X 20 ft. Std. No. 207.
SIZE OF EXCAVATION, IF NEEDED None
APPROXIMATE TIME WHEN WORK WILL BEGIN 12/31/91
• "":'fir •': --"ti� :.r:
APPROXIMATE TIME OF COMPLETION 1/6/92 �"' A•
ESTIMATED CONSTRUCTION COST $ '1-100-00 , r
(Including removal of all obstruction, • materials, and debris,'backfilling, com-f 1
paction' and placing 'permanent resurfacing and/or replacing improvements)
In consideration of the granting of this, permit, the applicant hereby' agrees to: ,� • i
'�
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all ,
ti penalties, liabilities or loss resulting from claims or court action and arising out -of any accident; loss or damage to persons or property
r happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Admihisfrative'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 I
La Quinta and to pay for any additional replacement necessary as•the result of, this work.'N i
h
Signature of Applicant or Agent
..Tames 8. Van Dorn 74-867 Velie Way Palm Desert, CA 92260 340-6484
Name of Applicant (please print) 'Business Address , �{ Telephone No.
Same
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. ' City Business License No.
State Farm/.Palm'Desert 83-3139A
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit - Class I II
Public improvements:'3%'of estimated construction costs
• P,rivate improvements: 3% of estimated construction 13,20,
Minor Improvement Permit— Class IV: See attached schedule
Inspection Fee $ II PERMIT VALIDATION
Permit Fee '0"'
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ —0— 4
Receipt No.
Received by
Recorded by
Date
1320
PERMIT NO.
DATE APPROVED 12/31/91
EXPIRATION DATE 1/10/92
DATE ISSUED 12/31/91
By./��
Administrative Authority
TELEPHONE: (619) 564-2246
41
ar
Jot
,.'Nf�T,Ec.. �, I u
Vl�th pro er validation ,
w_thii,46rm,constitutes an
4
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
`December 31, 1991 Subdivision Improvement Permit— Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 46290 Cameo Palms Drive La Quinta, CA 92253
(Street address or Description, of Location), M • Y} _ f
PURPOSE OF CONSTRUCTION . Bring driveway/approach Sketch (attach constructionlans if a
to code. P appropriate)
DESCRIPTION OF CONSTRUCTION Removal of existing
driveway/approach and replacement. See attached Riverside County
DIMENSION OF INSTALLATION OR REMOVAL • 40 X 20 ft. Std. No. 207.
SIZE OF EXCAVATION, IF NEEDED None
APPROXIMATE TIME WHEN WORK WILL BEGIN 12/31/91
• "":'fir •': --"ti� :.r:
APPROXIMATE TIME OF COMPLETION 1/6/92 �"' A•
ESTIMATED CONSTRUCTION COST $ '1-100-00 , r
(Including removal of all obstruction, • materials, and debris,'backfilling, com-f 1
paction' and placing 'permanent resurfacing and/or replacing improvements)
In consideration of the granting of this, permit, the applicant hereby' agrees to: ,� • i
'�
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all ,
ti penalties, liabilities or loss resulting from claims or court action and arising out -of any accident; loss or damage to persons or property
r happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Admihisfrative'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 I
La Quinta and to pay for any additional replacement necessary as•the result of, this work.'N i
h
Signature of Applicant or Agent
..Tames 8. Van Dorn 74-867 Velie Way Palm Desert, CA 92260 340-6484
Name of Applicant (please print) 'Business Address , �{ Telephone No.
Same
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. ' City Business License No.
State Farm/.Palm'Desert 83-3139A
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit - Class I II
Public improvements:'3%'of estimated construction costs
• P,rivate improvements: 3% of estimated construction 13,20,
Minor Improvement Permit— Class IV: See attached schedule
Inspection Fee $ II PERMIT VALIDATION
Permit Fee '0"'
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ —0— 4
Receipt No.
Received by
Recorded by
Date
1320
PERMIT NO.
DATE APPROVED 12/31/91
EXPIRATION DATE 1/10/92
DATE ISSUED 12/31/91
By./��
Administrative Authority
TELEPHONE: (619) 564-2246
41
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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 I I I
DATE: V2 -30 -9.1 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 4(o2 -C40 Co-ryi e) Pcd ynS D 21 V -e
Lip, OU.,I h C__A `i a -ICS 3
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION. DR I vt�y /¢P/pj��l Sketch (attach construction plans if appropriate)
IPTION OF CONSTR
DIMENSION OF INSTALLATION OR REMOVAL f 07`22-0 F -T_
SIZE OF EXCAVATION, IF NEEDED )/OWE
APPROXIMATE TIME WHEN WORK WILL BEGI
APPROXIMATE TIME OF COMPLETION 1,6�
ESTIMATED CONSTRUCTION COST $ /�bivp
(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 appl' ble rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of h' wor .
Sigpdrure of Applicant or Agent
Name of Applicant (please print) ;-:,__ .. Business Address Telephone No.
5l�ryr Vie` z'�- 0
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
S FAftn'1 l Attw OtS£
Applicant's Insurance dompany
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
City Business License No.
Policy Number
1236
PERMIT VALIDATION
PERMIT NO. '
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Recorded by 1. 11 TELEPHONE: (619) 564-2246 .
Administrative Authority
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