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1362"- NOTE: With proper validation this form constitutes an encroachment permit CITY OF LA QUPNTA 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 II I DATE: February 19, 1992 Minor Improvement Permit Class IV 53-915 Avenida Madero LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveway approach DESCRIPTION OF CONSTRUCTION Driveway approach DIMENSION OF INSTALLATION OR REMOVAL r SIZE OF EXCAVATION, IF NEEDED Sketch (attach construction plans if appropriate) Per Riverside County Std. No. 207, attached. ' O , 82 CASti7 12 %L %L20i X32 3'a. 0V APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION b9Z 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: 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 condition 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 esult of 'A's ` Signature o Applicant or Agent David Ross Mi11er P.O. Box 722 La Quinta, CA 92253 564-5823 Name of Applicant (please print) Business Address Telephone No. Same Name of Contractor and Job Foreman Business Address Telephone No. 425381 - Contractor's License No. City Business License:No. Farmers Insurance 91082 81 02 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 $ 20.00 Permit Fee 10.00 Penalty Cash Deposit -Surety Bond if required 30.0 TOTAL: $ Receipt No. Received by Date PERMIT NO. PERMIT VALIDATION 1362 1362 DATE APPROVED 2/19/92 EXPIRATION DATE 2/28/92 2/19/92 DATE ISSUED By :: A " Administrative Authority Recorded by II TELEPHONE: (619) 564-2246 '. .. � ♦V - ' . . .. � , •• �' 'J 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 O� Subdivision Improvement Permit — Class III DATE: l �' _ Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION S �– Hor9W (Street address or Description of Location) PURPOSE OF CONSTRUCTION DRI 0Lu3ki AMP DESCRIPTION OF CONSTRUCTION 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 I �Y ESTIMATED CONSTRUCTION COST $ �a — (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 conditio f the per ' and all applicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as the r ult of t i o C c7 SS k�) k'Q�k1 Liz,, Signature ofpplicant or Agent -7Z(ILL. 'a) . S9 q__59z 3 Name of Applicant (please print) Business Address Telephone No. �, Name of Contractor and Job Foreman Business Address Telephone No. q L 3441 Contractor's License No. City Business License No. r -gem w2 , S q 16 Z 5-( © 2, 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 $ .001�tq Permit Fee 10 Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by Recorded by Date PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By TELEPHONE: 16119) 564-2246 1350 Administrative Authority