1374t
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 ClassflII ,
DATE: March 5, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-830a 53840 Herrera and 53-065 Obregon
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Curb cutting Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Driveway ARproachest Per Riverside County Std. No. 207,
attached.
DIMENSION OF INSTALLATION OR REMOVAL
'SIZE OF EXCAVATION, IF NEEDED `
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/5192 4 2 1Q $ 5 O —112 i4
i111
tt CASH � TdTAL � . '0,40
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ Od
(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 ofany 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.
otify 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
La Quinta and to pay for any additional replacement necessary as the result of this work. ,
Signature of Applicant or Agent
David Dietrick 45-320 Driftwood Dr. Palm Desert, CA 341-1426
Name of Applicant (please print) Business Address Telephone No.
aura
Name of Contractor and Job Foreman Business Address Telephone No.
260484 2279
Contractor's License No. City Business License No.
Mate Compenaation Fund
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
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 60.00 1 11
Permit Fee
10.00
Penalty
Cash Deposit -Surety Bond _
if required
TOTAL: $ 70.00
Receipt No.
Received by
Recorded by
Date
1 374
PERMIT VALIDATION
PERMIT NO. 1374
t DATE APPROVED 3/5/92
EXPIRATION DATE 3/13/92
DATE ISS ED 3/5/9
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'
r
/ Subdivision Improvement Permit — Class I I I
DATE: c3 ��� — �,� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 3 - D 2!52R E-44
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION L lL
DESCRIPTION OF CONSTRUCTION
Sketch (attach construction plans if appropriate)
AvFesrV iE CoK+jT�
dip
DIMENSION OF INSTALLATION OR -REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 2 yes 220
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 pursuint to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance ofrthe .-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
La Quinta and to pay for any additional replacement necessary as the result of this work.
�
Signature of Applicant or Agent
_ 401�l F i �2 /Cry -39�/ �Pi�i�� i� i%� A D 3 S� /�Z (p
Name of Applicant (please print) . Business Address 44 Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
ST.AF%E OFVVP£il/<S•lf /&V f UN n ,
Applicant's Insurance Company. - Policy Number
FEES: Subdivision Improvement Permit —Class I II Y
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1350
Minor Improvement Permit — Class IV: See attached schedule '. ,
®O r _ '
Inspection Fee $� PERMIT VALIDATION
Permit Fee
PERMIT -NO.
Penalty =� '� t r • '7 Z ' ! r �<Y S , o,�'` es�ikcs f5'� i K t ado-, S•}.X FJ ist
Cash�"� e - DATE APPROVED`—
-S r`
Deposit -Surety Bond h "� -v o�' '
.... i •F. %: wa '1•� "E rT. r• t; .. .� �� j ` t •'z!F3.�-h,��; ��
if required J EXPIRATION DAT >
RTOTAL ~'$ ;�®,�R, �� �,,,1� t�Z 'rs,'._..:�'-�5*
:DATE ISSUED w
p
Receipt No.}
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Recorded by
}.TELEPHONE: (6191,564-2246 �°'
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