1414*�. -_-___- -.a .._.. ��___:------- --__---------------------________--- -----
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
i'
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: 4-9-92
LOCATION OF CONSTRUCTION 52-755 Diaz
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
(Street address or Description of Location)
drivay approach
PURPOSE OF CONSTRUCTION 'Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION • Per Riverside County std. 207
DIMENSION OF INSTALLATION OR REMOVAL
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 willbe 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
James Sattley 41625 Eclectric Palm Desert, CA 340-1361
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.`
248823 865' ,
Contractor's License No. City Business License No. ' "i
travelers ins. 00018274 +
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 $ Z�
Permit Fee �p
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ -a
Receipt No.
Received by . Date
Recorded by '
00�5�.P2 �RSH014T04 09-92 30.00
PERMIT V'A'LIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUE q Z
By 21
-�
Administrative Authority
TELEPHONE: (619) 564-2246
.r
--------------'--------------------------------------I�
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 — Class I I I
DATE: `�7 Z— Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION _5 7
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION D6:1 -"V- WAI &PPRI"'C44 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 $
,(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 Quinta and to pay for any additional replacement necessary as the result of this work. /1
J A VMb25 S�q r—r(
Name of Applicant (please print)
SigrAture of Applicant or
IeLr e 6-'
Business Address
nt
7 3 cl o l 3 c/
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
2-4 8 8 Z!2 8&Y—
Contractor's License No. City Business License No.
kvh V (VL- I lis,. doe i NJ- 74
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
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
1Ila 86
Administrative Authority