1373�tN( i
With qrt*er validation 4 2
tWisyforin constitutes an CITY OF LA QUINTA o
encroachment permit
APPLICATION FOR PERMIT g
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
March 4, 1992 Subdivision Improvement Permit — Class I I I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION . 54-375 Ave. Obregon La Quinta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach
DESCRIPTION OF CONSTRUCTION Driveway approach
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/4/92
Sketch (attach construction plans if appropriate)
See Riverside County Std. No. 207,
attached.
APPROXIMATE TIME OF. COMPLETION 3/6/92
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 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.
r
Comply with all applicable City Ordinances,'the terms and'conditw of the p mit
La Quinta and to payand all applicable rules and regulations o e City of
4for'any additional replacement necessary as'"Oesult f tits work.
David Rose Miller
Name of Applicant (please print)
S, 1.>
Signature d1 Applicant or Agent
P.O. Box 722 La Ni nta, CA
Business Address
823
Telephone No.
Pacific Trades`
Name of Contractor and Job Foreman Business Address Telephone No.
8425381 '
Contractor's License No. t
City Business License No.
Farmers 91082 81 02
Applicant's Insurance Company Policy Number
1. 10
FEES: Subdivision Improvement Permit — Class I I I CASH 1 0 L 1~ 30.000
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
Recorded by
$ 20.00
10.00
Date
PERMIT VALIDATION
PERMIT NO. 1373
DATE APPROVED 3/4/92
EXPIRATION DATE 3/9/92
DATE ISSUED 3/4/92
By
Administrative Authority
TELEPHONE: (619) 564-2246
y ' NOTE:
With proper validation
this form constitutes an
encroachment permit CITY OF LA QUINTA
v
APPLICATION FOR PERMIT s
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
oa
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
March 4, 1992 Subdivision Improvement Permit —Class I I I
DATE:—
Minor Improvement Permit Class IV
j LOCATION OF CONSTRUCTION 54-375 Ave. Obregon La Quints.
! (Street address or Description of Location)
f PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Driveway approach See Riverside County Std. No. 207,
jattached.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/4/92
APPROXIMATE TIME OF COMPLETION- 3/6/92
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 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 124) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and condit teesult
e p mit and all applicable rules a=reguonse City of
La Quinta and to pay for any additional replacement necessary as f rk.
s J
David Ross Miller
Name of Applicant (please print)
Signature Applicant or Agent
P.O. Box 722 La inta CA
Business Address
Telephone No.
Pacific Trades
Name of Contractor and Job Foreman Business Address Telephone No.
B425381
Contractor's' License No. City Business License No.
Farmers 91082 81 02
Applicant's Insurance Company Policy Number i
FEES: Subdivision Improvement Permit — Class III �C H i 0 L 30.000
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs3 � J
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00 II PERMIT VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
Received by _.
Recorded by _
10.00
$ 10.00
Date
PERMIT NO. 1373
DATE APPROVED - 3/4/92
EXPIRATION DATE 3/9/92
DATE ISSUED, �/4/92
By �
Administrative Authority
TELEPHONE: (619) 564.2246
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
3Z Subdivision Improvement Permit — Class III
DATE: /Minor` Improvement Permit Class IV
LOCATION OF CONS RUCTION �—I — 3-7
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION �2 �J� �� cl A'D��� Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ► '.3'L—
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 007
(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 conditionf the permit and all applicable rules and regulations of the City of
La Quints and to pay for any additional replacement necessary as the re t of t i perk, J
SS
Signature of ApNcant or Agent
Name of Applicant (please print) . Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
�qz5�-3gl
Contractor's License No. City Business License No.
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
OTAL: Receipt No.
Received by Date
.t Recorded by
1350
PERMIT VALIDATION
PERMIT NO...
DATE.APPROVED
EXPIRATION DATE
DATE ISSUED ^_
By
. Administrative Authority
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