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1385� OOTE: 2� YIith proper validation x o� this form constitutes an CITY OF LA QUINTA encroachment permit 5,, -= 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,lll., DATE:_ Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 53-165 Avenida Rubio (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans if appropriate) ` r DESCRIPTION OF CONSTRUCTION 5 x 24 Per Riverside County Std. No. 207 Attached i DIMENSION OF INSTALLATION OR REMOVAL I SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION $400 ` 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 conditio4f�,P, ll applicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as h.C c 7ant or Agent David Ross Miller P.O. Box 72nta, CA 92253 564-5823 Name of Applicant (please print) Business Address - Telephone No. Pacific Trades Same as Above Name of Contractor and Job Foreman Business Address Telephone No. 425381 On Filer (1954) Contractor's License No. City Business License No. Farmers F 91082'81 01 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 $ 20.00 Permit Fee 10.00 Penalty Cash Deposit -Surety Bond, if required TOTAL: $ 30.00 Receipt No. Received by Date Recorded by G 005182 CAS8472 i' TOTAL 8-92 1300-00 PERMIT VALIDATION PERMIT NO. 1385 DATE APPROVED 3318/92 EXPIRATION DATE 3/25/92 DATE ISSUED 3/18/92 By dministrative Authority TELEPHONE: (619) 564-2246 S ,{ f� �� �� r r-+.���-rr.►aw�,i.Y`�� — _r r• r. — _� -- r r _�.� r — r —. r — ------------------ NOTE: _ -----__-------- 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 Subdivision Improvement Permit — Class III DQTE:- v I 1119 � Minor Improvement. Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION 42 29-2'4eLl Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION < < < I DIMENSION OF INSTALLATION OR REMOVAL - I x 20 SIZE OF EXCAVATION, IF NEEDED 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) 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 Condit' 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 ult of fts work. oSignure o Applicant or Agent JPrJ SSS o-'�, ��t2 `.�. �x at`?ZZ Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. `�Zs3�l Contractor's License No. City Business License No. rktk 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 r .Date Recorded by 1236 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE: (619) 5642246