13434
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
January 27, 1992 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-710 Avenida Navarro and 53-046 Avenida Diaz
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Curb cut for approach. Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION Curb saw and drive approach '
installation. Per Riverside County Std. No. 207,
attached.
DIMENSION OF INSTALLATION OR REMOVAL 20, ?-Df
SIZE OF EXCAVATION, IF NEEDED 1 X 6 X 24
APPROXIMATE TIME WHEN WORK WILL BEGIN 1/27/92
APPROXIMATE TIME OF COMPLETION 2/28/92
ESTIMATED CONSTRUCTION COST $
250.00 I
(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 (2-4) 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 Ag
General Contract Management T.O 59 La Quinta 564-1486
Name of Applicant (please print) Business Address Telephone No. +'
Michael L. Bangerter Same Same
Name of Contractor and Job Foreman Business Address Telephone No.
524-325 B CA 1235
Contractor's License No. City Business License No.
On File On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
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
60.00
$ 60.00 _
Date
Recorded by _
Opt i 82 GA H7 3�CM 71 92 60.600
1343
PERMIT VALIDATION
PERMIT NO. 1343
DATE APPROVED 1/27/92
EXPIRATION DATE 3/2/92
1'/27/92
DATE I SUf D
By
Administrative Authority
TELEPHONE: (619) 564-2246
Z�A • --:s-- ---- - - —————————————————————————————————————————————————-- — — -- —
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: �/� 2 Subdivision Improvement Permit — Class I II
+ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
/ t
PURPOSE OF CONSTRUCTION `-�'%r' ,A��r,�
( e� Sketch (attach construction plans if appropriate)
DESCRIPTIQN OF CONSTRUCTION
i IPAJ
DIMENSION OF INSTALLATION OR REMOVAL 't-70'
I
SIZE OF EXCAVATION, IF NEEDED Z X 4�' �.' 7 --
APPROXIMATE -TIME
APPROXIMATE•TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION ;fir y��Z
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, corn=
paction and placing permanent resurfacing and/or replacing improvements) _
Inconsideration 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.
Signature of Appli nt or -Agent
Name of Applicant (please print)
Name of Contractor and Job Foreman
Contractor's License No.
ness Address
Business Address
-I'
ngw1ellc�e
Telephone No.
Telephone No.
City Business License No.
Z-1
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 p, a—
Penalty `
Cash Deposit -Surety Bond
I
if requited
TOTAL: 0, v�
Receipt No.
Received by Date
Recorded by f
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE:.(619) 5642246