1421With 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
i
April 15, 1992 ��' r=•�M• i �y Subdivision Improvement Permit — Class I I I
DATE: MMinor.lmproyement Permit Class IV
54-295 Avenida Alvarado�s
LOCATION OF CONSTRUCTION
yjaY�
(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. 1=
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED •
805182 iASH0 1.45 p4-1592 i04
4/1,5/92
PROXIMATE TIME WHEN WORK WILL BEGIN
10 C 1 TOTAL 1 30.0
APPROXIMATE TIME OF COMPLETION 4/16/92 `
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 worl�.��
�Si§npture of Applicant or Agent,'
ectation Construction P.O. Box 1847 La Q nta, CA 564-0793 771-4501
Name of Applicant (please print) Business Address Telephone No.
Same
Name of Contractor and Job Foreman Business Address. Telephone No.
613406 0120
Contractor's License No. City Business License No.
State Wookers Comp. 1242686.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit'— Class 111
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
10.00
Permit Fee
Penalty
Cash Deposit -Surety. Bond
if required
30.00
TOTAL: $
Receipt No.
Received by
Recorded by
Date
14,21'
PERMIT VALIDATION
PERMIT NO. 1421
DATE APPROVED 4/15/92
EXPIRATION DATE' 4/26/92
4/15/92
DATE ISSUED ' A
By
Administrative Authority
TELEPHONE: (619) 564-2246
✓a � � >
i
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1
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--
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
c� Subdivision Improvement Permit — Class I I I
DATE:_ _���' / � c— Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S L �p/ \ 4 VA420n
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL /u,
SIZE OF EXCAVATION, IF NEEDED41010
APPROXIMATE TIME WHEN WORK WILL BEGIN L- I -S -9a
Sketch (attach construction plans if appropriate)
jq ;-
APPROXIMATE TIME OF COMPLETION el—Is—
ESTIMATED
l Is—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.
gna re of Applicant or Agent -7 -7
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
,/2/3 ion aia
Contractor's License No. City Business License No.
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 7 `q y 1
DATE APPROVED H
EXPIRATION DATE
DATE ISSUED y l S^ r
By
TELEPHONE: (619) 564-2246
186
Administrative Authority