1372;I OIE.
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: March 4, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-640 Avenida Ramirez La Quints, CA'"'
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Driveway approach
See Riverside County Std. No.9207,
attached.
DIMENSION OF INSTALLATION OR REMOVAL An=rnx.-")AI im»rhing
SIZE OF EXCAVATION, IF NEEDED ,
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 3/11 99fK.
ESTIMATED CONSTRUCTION COST $ 400-00
(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'anyla d all
penalties, liabilities or loss resulting from claims or court action4and arising out of any accident, loss or damage to persons o�'p,roperty
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.
0. ..
,
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.
f
Signa u of Applicant or Agent
M L Construction 'P.O. Box 228 564-4447
Name of Applicant (please print) Business Address Telephone No.
Marviu" 'L. Jor"n
Name of Contractor and Job Foreman Business Address Telephone No.
3b3335 2051
Contractor's License No. City Business License No.
Socttsdale Ins. Co. GLS434495
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 estimdtbd construction costs
w '
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond XX
if required I`
30.00 �--
TOTAL: $ ..-
Receipt No.
Received by Date
Recorded by
"r
0051820CA$H i� TO A L 1 92 30.000
1372
PERMIT VALIDATION
)PERMIT NO. 13%2
DATE APPROVED x/4/92
EXPIRATION DATE 3/13/92
DATE ISSUED 3/4 • 2
By
Administrative Authority
TELEPHONE: (619) 564-2246
�.
,a.:
��,�,
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - --
NOTE: -
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 Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
�A- 06///t/ 7-4
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION — 0 21 V tali(/ /4 `/ Sketch (attach construction plans if
A P/21ZO 4c I-( P appropriate)
DESCRIPTION OF CONSTRUCTION - 0 ✓2 1 V Ct06- —k-1 19-t'leo
DIMENSION OF INSTALLATION OR REMOVAL
APO1P0X. Zo' c+ ,)rll3r,UG rU 43E 12(;7677
SIZE OF EXCAVATION, IF NEEDED AJ V N L=
APPROXIMATE TIME WHEN WORK WILL BEGIN -? — Z' — `7 2—
APPROXIMATE TIME OF COMPLETION — I I — 9
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 conditions of the permit and all applicable rules and regulations of the City of
L.a Ouinte and to pay for any additional replacement necessary as the result of this work.
M L LyNS T/zuG 7 /D
Name of Applicant (please print)
IvIff rwl N /_- j-�)
Name of Contractor and Job Foreman
3y3.33�;-
Contractor's License No.
3, Co.
Sig ature of Applicant or Agent
0- OdX Zzk-
Business Address
Telephone No.
. It
Business Address Telephone No.
aof-/
City Business License No.
G/_S4f3ejy4S
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 $
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
Administrative Authority
TELEPHONE:. (619) 664-2246—
Business
642246
X4.1'