1329NOTE: ,
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT {
PUBLIC WORKS CONSTRUCTION (ENCROACHMEN,T)c�, t• �,S`q��
SOF
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
t ' Subdivision Improvement,Permit — Class III ' t
DATE: January 13, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78-395 Palm Garden Place La Ouinta.- CA 92253
(Street address or Description of Location) i
PURPOSE OF CONSTRUCTION Replace driveway Sketch (attach construction plans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION 8sphalt ,driveway to be M
replaced- by Gement. Per Riverside County Std. 207,- '
attached.
DIMENSIOWOF INSTALLATION OR REMOVAL '
SIZE OF EXCAVATION, IF NEEDED r
APPROXIM TE TI E HEN WORK WILL BEGIN
13etureen Jan. a
�V ,
to .Jan. �5, � 192 ;�•
APPROXIMATE TIME -OF COMPLETION
January '2 5, 1992
3,000.00 µ _
ESTIMATED CONSTRUCTION COST $ +
(Including removal of. all obstruction, materials, and debris, backfilling, com--
I�, paction .and placing .permanent resurfacing and/or: replacing improvements) '
In consideration ofthe granting of this permit, the applicant hereby agrees to:
i
4
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 prope, rty
J 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 terrris•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.
RQ VA, K. NAJ
Sje4ature'of Applicant9
or Agent
Hovak Najarian 564-4689
Name of Applicant (please print) ' Business Address Telephone No.
Nner/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 a
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs A
Private improvements: 3% of estimated construction costs 1.329.
r
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee —C—
Penalty
CashO61posit-Surety Bond
if reR ed ,
TOTAL: $ _0_
Receipt No
Received by _
a
Recorded by _
m
Date
1
PERMIT NO
PERMIT VALIDATION
1329
DATE APPROVED 1/13/92
EXPIRATION DATE 1/27/92
1
DATE ISSUE 1/13492
By
Administrative Authority
TELEPHONE: (619) 564-2246
i
NOTE:
With proper validation
this form constitutes an
encroachment permit CITY OF LA OUINTA
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
DATE:_ J�lI�, �3, t01012 Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78-3R5 EALM GARDEN PLACe
I QTA, cA a.�5 3
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION — SCLELACE DP\VE AY Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION ASpFNLI D121 VF WAY in
2r nom. .x,._� n. — —
DIMENSION OF INSTALLATION OR REMOVAL
l r X (O�
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
j AiQ 1 X31, Tp �4 1 ct � 2.._
APPROXIMATE TIME OF COMPLETIONJ j '2—
ESTIMATED CONSTRUCTION COST $ _77,000, c
(Including removal of all obstruction, materials, and debris, backfilling, corn
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 Ouinta and to pay for any additional replacement necessary as the result of this work.11'�
HOVAK IJAJA
Signature Applicant or Agent
Noyn,K 1�1A /-�RiAIJ 565 g689'
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 $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE:. (619) 6642246