1358K
NOT C,:-
With proper validation
this form constitutes an
encroachment permit
R ,
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
DATE: February 12, 1992 Minor Improvement Permit Class IV
,LOCATION OF CONSTRUCTION 54-100 Avenida Montazima
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans if appropriate)
� I
DESCRIPTION OF CONSTRUCTION Per Attached. Per Riveside County Std. #207 (attached)
16' of concrete
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 2/17/92 I
APPROXIMATE TIME OF COMPLETION 2/17/92
ESTIMATED CONSTRUCTION COST $ 500.00
(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 advance of the time when work will be started. -4
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 is work.
w,
Signature of Applicant or ent
t
Dodco Construction P.O. Box 1012 La Quints, CA 92253 564-6478
Name of Applicant (please print) Business Address Telephone No.
Dan Featheringill
Name of Contractor and Job Foreman Business Address Telephone No.
A0877618 1375
Contractor's License No. City Business License No. `
r`
State Farm 90-384687-2
^ .Applicant's Insurance Company � Policy Number
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of estimated construction costs
` Private improvements: 3% of estimated construction costs
r
Minor Improvement Permit — Class IV: See attached schedule
r
"Inspection Fee $ 20.00
Permit Fee 110.00
Penalty
Cash Deposit -Surety Bond 11
if required J�
r�
TOTAL: $ .30-100
Receipt No. y+"
Received by Date
Recorded by
Nil
00518276 00
IT CA$HL
i� 0 1 300.0
PERMIT VALIDATION
PERMIT NO.
1358
2/12/92
DATE APPROVED
EXPIRATION DATE
2/17/92
DATE ISSUED
2/12/92
By
Administrative Authority
TELEPHONE: (619) 564-2246
..�
..
� �.;
. -._r
r; -, , ,
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit '
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
- - Subdivision Improvement Permit - Class I I I
DgTE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION - Sof _ /00 ,qV(1 l✓" nD y.in .✓�
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION AIVA u' ia
fir
DESCRIPTION OF CONSTRUCTION ^- c to
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION -- Z - 17 -9Z
ESTIMATED CONSTRUCTION COST $ 5-00
(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 advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all a able rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this wo
411 n .1% SignattIYe of Applicant or Agent
0Uc-d La"
Name of Applicant (please print)
Business Address
Telephone No.
Name of Contractor and Job Foreman / Business Address Telephone No.
Contractor's License No. ibity Business License No.
.-C-- jj,- aU acl%- 3y --aF7 -Z
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit - Class I I I
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
1236
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authority