1323-77
NOTE:
With proper validation . 4
this form constitutes an CITY OF LA _ QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) • `'»� S�,�/C
0
For the construction of public or private rcurbs, driveways, pavements, sidewalks, parking' lots, sewers, water mains_
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
January 6,• 1992 Subdivision Improvement Permit — Class I I I�»�;
DATE: Minor'Improvement Permit Class IV
iOCATION OF CONSTRUCTION `2 approaches — 78-435 Sand Mower Place and the lot directly
behind, access on Palm Garden. f t
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION" Driveway approach ,Sketch (attach construction plans if appropriate)
'DESCRIPTION OF CONSTRUCTION Standard driveway approach.' Construct per Riverdide County Std.
No. 207 (attached)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED ^. "
APPROXIMATE TIME WHEN WORK WILL BEGIN 1"8"92 '
APPROXIMATE TIME OF COMPLETIOI4"11-92
ESTIMATED CONSTRUCTION„COST $ 250.00
(Including removal of all obstruction,• materials, and debris, backfilling, com- t
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'withkall applicable City Ordinances, the terms and conditions of the er it an• regulations of the City of
yndl.la�Zjbleiles
La Quinta and to pay -for any additional replacement necessary as the resu, f his
' •gnature ofAppl'cant or t
Alan R. Pollock 78=345 Sand'Flower 564-1670
Name of Applicant (please print). Business Address Telephone No.
{
Owner.Builder
1r
Name of Contractor.and Job Foreman Business Address Telephone No.
)
• Contractor's License No. City Business License No.
i
_ Applicant's Insurance Company. Policy Number '
-FEES: Subdivision Improvement Permit —Class III
'
F Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor'lmprovement.Permit — Class IV: See attached schedule _
Inspection Fee $ PERMIT VALIDATION
Permit Fee -0- 1323
PERMIT NO.
Penalty 1/6/92
Cash Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE 1/1'3/92
TOTAL: $ 1/6/92
DATE ISSUED
Receipt No.
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
1 �;
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 III
D9TE: ' _ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTI / y 3� �0�0/,�
vn/ /AGA
(Street address or Description'of Location)
PURPOSE OF CONSTRUCTION �� �✓� ��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 — -e_-
Colo [ S/ esT17 /✓o . Zo%
(/gTTAc14C10
APPROXIMATE TIME OF COMPLETION -a — �. 2
ESTIMATED CONSTRUCTION COST $ -- _ Co'^
(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 permi and.all applicable rules an ulations of the City of
La Quints and to pay for any additional replacement necessary as the result of is cork.
of Appl
f -7�E-- 4 3
Name of Applicant (please print) Business Addre
Name of Contractor and Job Foreman Business Address
Contractor's License No.
Telephone No.
Telephone No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: - Subdivision Improvement Permit-- Class l 11
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
Recorded.by.
1236
PERMIT VALIDATION
,PERMIT NO. �23
DATE APPROVED _ Cl Z
EXPIRATION DATE f 7— 9 Z
DATE ISSUED /`I Z
By
t' Administrative Authority
TELEPHONE::'.(619) 564-22461