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13477t;A NOTE: ' With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) y 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 54-620 Digi and 53-640 Juarez' (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach constructions lariif p � appropriate) DESCRIPTION OF CONSTRUCTION Cutting curb for driveway. Per Riverside County Std. 207, attached. DIMENSION OF INSTALLATION,OR REMOVAL- 17 driveway, 21 on ,- + each side, angle cut. SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 1/28192 92 or dog 1�� Q •� 3g pq_4 _figi 1/29/92 ; ', _ i ,' CSN ,TOTAL .6'4004 APPROXIMATE TIME OF COMPLETION 1 . day. , ESTIMATED CONSTRUCTION COST $. 200.00 T ' (Including removal 'of all obstruction, materials, and debris, backfilling, com- 4. 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 Quinta and to pay for any'additional replacement necessary as the result of this work. gnature o�%,,14pplicant WAgent Bar Con Development 41-625 Eclectic St. Palm Desert; CA 92260 773-9024,' Name of Applicant (please print) Business Address Telephone No. John Clapinski Name of Contractor and Job Foreman Business Address , Telephone No. 0580-0581 121.9 Contractor's License No. City Business License No. Assurance Company of America ECA10777234 Applicant's Insurance Company Policy Number ' t� FEES: Subdivision Improvement Permit — Class I Public improvements: 3% of estimated construction costs[�j���r Private improvements: 3% of estimated construction costs 1.347 Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ 40.00 PERMIT VALIDATION 20.909 I 1347 t Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. $ 60.00 Received by Date Recorded by PERMIT NO. DATE APPROVED 1•/27/92 EXPIRATION DATE 2/5/92 DATE ISSUED 1/27/92 By Administrative Authority TELEPHONE: (619) 564-2246 r 0 -".------ --------------------------------------------------------- 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 I�.� Subdivision Improvement Permit - Class III DgTE: p� 7A.Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION �� �- LZ0 31 -Z 4 -3 - Ll (2) O 11�r•`+� Z (Street address or Description of Location) PURPOSE OF ONSTR r- ©6L. DESCRIPTION OF Cq __ . . ON LQ11 D Q1 Ly �� Z DIMENSION OF INSTALLATION OR REMOVAL W SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIIM f: WgEN WORK WILL,BEGIN APPROXIMATE TIME OF COMPLETION..I ®ta ESTIMATED CONSTRUCTION COST $ LC12 'OO (Including removal of all obstruction., materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) Sketch (attach construction plans if appropriate) ZI �r 2d C_uT 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 Quinta and to pay for any additional replacement necessary as the result of this work. - S nature of Applicant o gent Name of Applicant (please print)Business Address Telephone No. 9 Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business License No. 2�5 � � � ECA 07j1�Zr 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 1236 Minor Improvement Permit - Class IV: See attached schedule Inspection Fee $ PERMIT VALIDATION Permit Fee PERMIT NO. Penalty Cash Deposit -Surety Bond DATE APPROVED if required EXPIRATION DATE TOTAL: $ DATE ISSUED Receipt No. By Received by Date Administrative Authority Recorded by TELEPHONE: (619) 564-2246.