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NOTE:
V.
A. With proper validation
` this form constitutes an CITY `OF LA QUINTA y
`{ encroachment permit
APPLICATION FOR PERMIT
F, 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 111
DATE: January 22, 199.1. Minor Improvement Permit' Class IV
LOCATION OF CONSTRUCTION ^ 54735 Alvarado,' La Quinta =
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Cut curb'and pour driveway Sketch (attach construction plans if appropriate)
anaroach. ,
DESCRIPTION OF CONSTRUCTION . Per Riverside Co. Std. No. 207,
attached.
!` DIMENSION'OF INSTALLATION OR REMOVAL
SIZE F
. O EXCAVATION, IF NEEDED 20
APPROXIMATE TIME WHEN WORK WILL BEGIN 271O/4 �t)'%'
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 400.00
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) R
In consideration of -the granting of this permit, therapplicant hereby agrees to -
Indemnify,;
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.
5 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 res�Iltffs wIV—
o'
S n t re of Applicant or Agent
Expectation`Constlruction 54295'Diaz' La Qu n CA 564-0793 a
-
Name of Applicant (please print) Business Address Telephone No.
Jiu�Snell.enberger Same
Name of Contractor and Job Foreman Business Address Telephone No.
613406 - E_
0105
Contractor's License No.' City Business License No +
Applicant's Irisurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III'
OOSi820 �0 -22-92
Public improvements: 3% of estimated construction costs i0 CAS i TOTAL i�.' ..
Private improvements: 3% of estimated construction costs 0
,
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00 PERMIT VALIDATION
Permit Fee 10.00 PERMIT NO. 1340
Penalty W 1(_�\
Cash Deposit -Surety Bond
if required
TOTAL:
1 11
Receipt No.
Received by Date
Recorded by
DATE APPROVED 1/22/92
EXPIRATION DATE �w`2i�2 3��
DATE ISSUED 1/22/92
By
Administrative Authority
+
TELEPHONE: (619) 564-2246
c
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
DATE
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRLICTInnI
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMA E TIME WHEN WORK WILL BEGIN
L' C4 te13
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(/�r2 A oo
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, b3cl;filling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Sketch (attach construction plans if appropriate)
�Efz_. rL�.J Co
t FJ o 020 7 1 {'v�b eJbt�J
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 permit and all applicable rules and regulations of the City of
La Quints and to pay for env additional replacement necessary as the result of this work. � A
Name of Applicant (please print)
bignAtire f Applicant or Agent
12114 Z 6 -6 7
Business Address Telephone No.
/ A,;Il
Name of Contractor and Job Foreman Business Address Telephone No.
C/o �, O/O
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 coati
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ OrZ O
Permit Fee J0
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $-
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATEZ-
DATE ISSUED Z Z C Z
By
Administrative Authority
TELEPHONE:- (619) 6642246 -