1345,.�V.
-NO, E: i
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2
proper validation 4
this form constitutes an o
- 1, k CITY OF LA QUINTA
.,encroachment permit
�. APPLICATION FOR PERMIT
' PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OF TR8
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 1 21�r . Subdivision Improvement Permit — Class I II
a , 99
Y ri ,
DATE. Minor m
o Improvement Permit Class IV
LOCATION OF CONSTRUCTION 42815 Martinez
(Street address or Description of Location)
•'Driveway'approach
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Driveway approach
installation tt Per Riverside County Std. No. 207,
• r
attached.
DIMENSION OF INSTALLATION_ OR REMOVAL
II '
SIZE OF°EXCAVATION; IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1./27/92 AM
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ •1; RSR.RR
(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 .perm it, 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.
y 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. w
' Signature of.Applicant or Agent '
Werner Boettcher r
Name of Applicant (please print) - Business Address Telephone No.
Owner/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
FEES: Subdivision Improvement Permit — Class 111 }' 01t?t2CASH7`3 T0L271 92 30.00
Public improve ments:'3% of estimated construction costs q
Private improvements: 3% of estimated construction costs
- Minor Improvement Permit'- Class IV: See,attached schedule I
20.00
Inspection Fee ' $ PERMIT VALIDATION
10.00 I
Permit Fee ' P
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
30.00
Receipt No.
Received by Date
Recorded by
E 1345
RMIT NO.
DATE APPROVED 1/27/92
1/31/92
EXPIRATION DATE
1/27/92
DATE ISSUED
By
/k�ministrative Authority
TELEPHONE: (619) 564-2246
-- - - - - - - -
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:�.- 7_�Z Subdivision Improvement Permit -Class I II
_ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION _ �I � � I S~ ��lA�l/yl.P/tii
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTIOI%OF CONSTRUCTION
Sketch (attach construction plans if appropriate)
P"JP-t,tz�31 Ilk Ca,
DIMENSION OF INSTALLATION OR REMOVAL i
I
SIZE OF EXCAVATION, IF NEEDED I
APPROXIMATE TIME WHEN WORK WILL BEGIN _� - .�%•
APPROXIMATE TIME OF COMPLETION, W7 .
ESTIMATED CONSTRUCTION COST $ _ -
(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:
,--,q (> 1,) a `R 0-7 QW -7^c, �)
Indemnify, • defend and save the City, its authorized, agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or los 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 Quints and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
it VL P L/, --R
Name of Applicant (please print)
of Contractor an o reman
Contractor's License No.
Applicant's Insurance Company
A/CIZ 5uv
30
FEES: Subdivision Improvement Permit -Class III
Business Address Telephone No.
Business Address Telephone No.
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit - Class IV: See attached schedule
Inspection Fee $ O�Z�
Permit Fee /0
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30
Receipt No.
Received by Date
Recorded by
City Business License No.
Policy Number
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED Z-7- 9 2
EXPIRATION DATE L 31^ IZ
DATE ISSUED /- 2 7 � ?
By
Administrative Authority
TELEPHONE: (619) 564-2246