1322NOTE:
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
41
December 31, 1991 Subdivision Improvement Permit — Class II I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78451 Crestview Teatice
(Street address or Description of Location) V. -
PURPOSE
PURPOSE OF CONSTRUCTION Replace blacktop driveway
DESCRIPTION OF CONSTRUCTION install concrete driveway.
DIMENSION OF INSTALLATION OR REMOVAL 18 X 22
Sketch (attach construction plans if appropriate)
Per attached Riverside County Std. 207.
SIZE OF EXCAVATION, IF NEEDED None
APPROXIMATE TIME WHEN WORK WILL BEGIN 1/2/92
APPROXIMATE TIME OF COMPLETION
1/6/92
ESTIMATED CONSTRUCTION COST $ 19500.00
(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 andtarising out of any accident, loss or damage to persons or, property
happening or occurring as approximate 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
U€sxraxi .F. R14. 9 78451 Crestview Tarr. g64-4359
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 Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1322
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
—0-
-0—
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1322
DATE APPROVED 12/31/91
EXPIRATION DATE 1/10/92
DAT �SUED 12/31/91
By
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With
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
�a� �� t / Subdivision Improvement Permit — Class I I I
DATE: f �7 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION — ! ���� L�,5-f_067 �le
(Street address or Description of Location)
L�1 10� Q1 V� Sketch (attach construction plans if appropriate)
PURPOSE OF CONSTRUCTION kabLE
D SCRIPTION OF CONSTRUCTION E
P
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED w D
APPROXIMATE TIME WHEN WORK WILL BEGIN JAAQ 24 MEL—
APPROXIMATE TIME OF COMPLETION J 9
ESTIMATED CONSTRUCTION COST $ /✓EGD
(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. A
'
Signature of Applicant or Agent
WAaQEN �, kiss ,;�¢ �f_7_7 g
Name of Applicant (please print) Business Address Telephone No.
k0,V c 0WV16le
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
1236
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246