1330_N_7 '74 — — — — — — —
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NOTE:
With proper validation
this form constitutes an'` -,CITY OF LA QUINTA
encroachment permit 4 s
' 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
i
January T3, '] 992 Subdivision Improvement Permit —Class I I I
DATE: ,. Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-950 Mendo;4
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Per Uveraide County Std. 2079
attached.
DIMENSION OF INSTALLATION OR REMOVAL 161 wide by
U.,
MItU� y
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1/13/92
APPROXIMATE TIME OF COMPLETION 1/15/92
ESTIMATED CONSTRUCTION COST $ 200.00 r
(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 advanc of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the lermit 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�-woJrk.
ig ture of Applicant or Agent
Joe W. Stemmer, 52-425 Ave. Herrera L rota, CA 92253 564-4580
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman ; Business Address Telephone No.
Owner/Builder'
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number'
FEES: Subdivision Improvement Permit — Class 111 %,
Public improvements: 3% of estimated construction costs�g �i 7
Private improvements: .3% of estimated construction costs 100511
C0NOi -To AL011 1 00
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00 PERMIT -VALIDATION
Permit Fee 10.00 133U
PERMIT NO
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No. .
Received by Date
Recorded by
DATE APPROVED 1./13/92
EXPIRATION DATE 1/17/92
1/13/92
DATE ISSUED
By I.
Administrative Authority
TELEPHONE: (619) 564-2246
10
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
DgTE: /' 1 -3 -"
Subdivision Improvement Permit - Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION _�Z ��� f��il��0�'�'
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION —A 41L� Y['L,.-
DESCRIPTION
,1
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION -- L /S `
ESTIMATED CONSTRUCTION COST $%y `t -O&
(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:
Skeet -ch (attac construction plans if appropriate)
�� vE
&vr✓ rcm btsz>,
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 persona 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 rmit and all applicable rules and
La Q,uinte and to pay for any additional replacement necessary as the result f this work, pp regulations of the City of
Name of Applicant (please print)
blg ture of// )Applicant or Agent
Sc� `� vim, l-F�if `,nom ✓\Ia
Business Address
Telephone No.
Name of Contractor and Job Foreman Business Address
p Telephone No.
(2/21 dj �,11Z /' v I
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
TELEPHONE: (619) 5642246
Administrative Authority