1404•-----:-- .,------- ---------+---------------- --_---_----------_--------.------_------------------------
__,,
NOTE:
With proper validation
this form constitutes an
encroachment permit-- .
M 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
March 27, 1992
LOCATION OF CONSTRUCTION 53-815 Vallejo
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach. Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Per Riverside County, Std. No. 207,
attached.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED _
005182 10 7 5 2? -9 14
10 APPROXIMATE TIME WHEN WORK WILL BEGIN 3 L l CASM TI�A(. 1, 30.OU
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) hou'r's 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 a d 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
Timothy S. Farcy 81824 Trader Pl. Indio, CA 775-1760
Name of Applicant (please print) Business Address Telephone No.
Same as above
Name of Contractor and Job Foreman Business Address Telephone No.
562506 a, ,
Contractor's License No. City Business License No.
8328111 Sf igni & Hannan EPT 137602 78
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 $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
20.00
10.00
$ 30.00
Received by Date
Recorded by
1404
_r
PERMIT VALIDATION
PERMIT NO. 1404
DATE APPROVED 3/27/92
EXPIRATION DATE 4/3/92
DATE I SU D 43/27/92
TA
By
III N
Administrative Authority
TELEPHONE: (619) 564-2246
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: 3�2 -/Z9 Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION - IV,53' 8/S 1/4 LC e;p
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 5:1 f0P2o4 c h
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
\;J>z
S,C
D
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN Zo'
APPROXIMATE TIME OF COMPLETION 7, 2
ESTIMATED CONSTRUCTION COST $ 5.5-0 t— 6
.(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) C�K L3
In consideration of the granting of this permit, the applicant hereby agrees to: 2.z
11
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
La Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of A plicant or Agent
/ I rm o T -t K SF,5k Ra c X e4 cPsR �- 6 g 775 =/ 76 0
Name of Applican (please print) Business Address Telephone No.
5a,".0 0.0 �P
Name of Contractor and Job Foreman Business Address Telephone No.
2— 9-0(,,
Contractor's License No. City Business License No.
S - -i-
Applicant's
i -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 $ ez o
Permit Fee 10
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ `?2
Receipt No.
Received by Date
Recorded by
1386
PERMIT VALIDATION
PERMIT NO. -
0
DATE APPROVED
q
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authority