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1412i' NOTE: With 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 I I I DATE: April 9. 1992 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 54 -355. -Avenida Obregon / S4 -6o5 ohre8on (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveway Approach 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 APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ 450.00 Each (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: Per Riverside County Std No. 207 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 Applicant or Agent David Ross Miller P.O. Box 722 La Quinta, CA 92253 564-5823 Name of Applicant`(please print) Business Address Telephone No. Pacific Trades Same Name of Contractor and Job Foreman Business Address Telephone No. B425381 x.1955 Contractor's License No. City Business License No. Farmers Insurance 90956 94 00 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 �$ 40.00 Permit Fee �i1 10.00 Penalty s Cash Deposit -Surety Bond if required TOTAL: $ 50.00 Receipt No. Received by Recorded by Date 1.12 00 bg`ASHO ST#_AF ig` 50.. 0 PERMIT VALIDATION PERMIT NO. 1412 DATE APPROVED 4/9/92 EXPIRATION DATE 4/9/92 DATE ISSUED 4/9/92 By Administrative Authority TELEPHONE: (619) 564-2246 V_ 11 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 DATE: 7 11�?� Subdivision Improvement Permit — Class III �1 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION - - t>rt-%��-H— DESCRIPTION OF CONSTRUCTION :�; IN DIMENSION OF INSTALLATION OR REMOVAL L X Zo SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETIONiT/O ESTIMATED CONSTRUCTION COST $ �{St (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) Sketch (attach construction plans if appropriate) 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 an ions of the City of La Quints and to pay for any additional replacement necessary asZre sult this work. �SS Signature f Applicant or Agent �� mss , �`�� Pa. QX -?z t-. Q - of S'�Z3 me of Applicant (please print) Business Address Telephone No. a c.\ 1i;- �-L TQ, b t -S S -&-� 5 S`40�5 Name of Contractor and Job Foreman Business Address Telephone No. IRV 11Z53�S1 Contractor's License No. City Business License No. FAQ ti - 5 L(1)5- 969§6 C 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 1236 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE: (619) 5642246 . . �4r 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 DgTE: �bLCIZ Subdivision Improvement Permit —Class I I I Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION _�� — �o�� `t ©tri i rm) (Street address or Description of Location) PURPOSE OF CONSTRUCTION V Q\ 04 `-� i' o10 Sketch (attach constructionlans if appropriate) ppropriate) DESCRIPTION OF CONSTRUCTION 5 4,�-, 7 - DIMENSION OF INSTALLATION OR REMOVAL ZD SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION r ESTIMATED CONSTRUCTION COST $ `f (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 La Quints and to pay for any additional replacement necessary as he cult of this work. v, Signature Q.0, Q) icant or Agent 2--2- L Q, - S6 q - SSS 2-3 Name of Applicant (please print) Business Address Telephone No. vc�- C r i C— `e(ZA fli�S 5 P t'\ l: S4%�—v S Name of Contractor and Job Foreman Business Address Telephone No. -�s`f 2-!� 381 PSI S �;- Contractor's License No. City Business License No. F44z- h tk-s T s . 90y s -L (� y o� 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. 1236 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED ` Received by -Date II By Recorded by TELEPHONE:: (619) Authority