1359•r,
DOTE•: a '
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ti
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 III
DATE: February 13, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-560 Ave. Alvarado, La Quinta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION curb cut and driveway
approach. Per Riverside County Std. No. 207,.'+.:
attached. ,
DIMENSION OF INSTALLATION OR REMOVAL X
_ t
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 92 005182 _1p 769 --13-92 i4
JO,,. CAsff 1 T''GTAL it 30.00
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 00.00
(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 o� 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 cci{orfs—of the p it and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessar as the result o _tKis_w_oork.
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if�required
.1
TOTAL:
Receipt No.
10.00
Received by Date
PERMIT. VALIDATION
PERMIT NO. 059
DATE APPROVED 2/13/92 • _ ('
,2/21/92
EXPIRATION DATE
DATEISS D If 2/13/ 4q2
By
77-"dministrative Authority
Recorded by TELEPHONE: (619) 564-2246
Signature of Applicant or Agent
J.W. Moffitt Construction/Devcon
83-616 Ave. 45;
Indio, CA
922-7351
Name of Applicant (please print)
Business Address
Telephone No.
Same/Ren Zwiefer
Same
770-9547
t�
Name of Contractor and Job Foreman
Business Address
Telephone No.
A-350561
93
Contractor's License No.
City Business License No.
Bausch Insurance Co.
CCP 139412
`
Applicant's Insurance Company
Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs
1 359
Private improvements: 3% of estimated construction costs
1
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if�required
.1
TOTAL:
Receipt No.
10.00
Received by Date
PERMIT. VALIDATION
PERMIT NO. 059
DATE APPROVED 2/13/92 • _ ('
,2/21/92
EXPIRATION DATE
DATEISS D If 2/13/ 4q2
By
77-"dministrative Authority
Recorded by TELEPHONE: (619) 564-2246
r
�,.?
�.
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
Subdivision Improvement Permit— Class III
DATE: Minor Improvement Permit Class IV
LOCATION O CONSTRUCTION 'S �[5/i A /J/ �lLdY,
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION itE122 e49ell
—
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
Fgx- -5.-b 0- Z o7
a'rkAc- t4 f C D
SIZE OF EXCAVATION, IF NEEDED ��' -Y649
APPROXIMATE TIME WHEN WORK WILL BEGIN —
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements►
AL-VA,4QA-b O
CVS
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 twent - ur (24) hour i advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as th resul of this work.
Signature of p licant r Agent
Name of Applicant (please print)
. Business Address
Telephone No.
Name of Contract6r. and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
�Cp / 3 / 2,
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
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
1350
Administrative Authority