1438----------=---------------------------------------------------------------------------- - - - - - -
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
May 15, 1992 "` ten.- .:.5:..,,y..,. Subdivision Improvement Permit —Class I
DATE: Minor impr6vement"PerrnitaGlasi�IV�12�-r`-_-
LOCATION OF CONSTRUCTION 78-545, 78-595 and 78-735 Sagebrush Ave.
(Street address or Description of'Location)
PURPOSE OF CONSTRUCTION Driveway auvroach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Concrete PER RIVERSIDE COUNTY STD. NO. 207,
ATTACHED.
r
DIMENSION OF INSTALLATION OR REMOVAL 161 from burb to
gatBQll. ip q86 05 4
00'682 CASH i�' TOTA[S i9` Z0. 0
SIZE OF EXCAVATION, IF NEEDED None
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/17/92
APPROXIMATE TIME OF COMPLETION 5/30/92
ESTIMATED CONSTRUCTION COST $' 840.00' 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:
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 oP 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 thermit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result t�t swork.
1
Signature ofAppfiXant or Agent
Robert Grimes
Name of Applicant (please print) Business Address Telephone No.
Garcia Concrete, Jesse 82358 Mountain View, Indio
Name of Contractor and Job Foreman Business Address Telephone No.
6187061 2105.
Contractor's License No. City Business License No.
State Workmens Comp. 1242868-91 y.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111 ^—
Public improvements: 3% of estimated construction costs / Q
Private improvements: 3% of estimated construction costs 1438-
Minor Improvement Permit — Class IV: See attached schedule . .
Inspection Fee $ 60.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 70.00
Receipt No.
Received by
Recorded by
Date
PERMIT VALIDATION
PERMIT NO. I QR
DATE APPROVED 5/15/92
EXPIRATION DATE 6/5/92
DATE IS OED 5/15/92
By
Administrative Authority
TELEPHONE: (619) 564-2246
1174
�, �N_______._____________.r____..______-________________._____z_______-__--___________-_____-______
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
- q Subdivision Improvement Permit -Class 111
D&TE: ._ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 70 SS
S— , %e S�1S-' 7,6-73� SigCjE/��C1S�
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL -- 4� 7/22, -141
SIZE OF EXCAVATION, IF NEEDED �oi1lE
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 30��4
ESTIMATED CONSTRUCTION COST $ A440,'
(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��f the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the peyrj�it and all applicable rules and regulations of the City of
La Quints and to pay for any additional replacement necessary as the result of s wok:.
Signature of Abp ro-Aor Agent
Name of.A,PPlicant (please print) Business Address Telephone No.
,�ES5E
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. f 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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 70
Date
1236
PERMIT VALIDATION
PERMIT NO. /y-33
DATE APPROVED S -r /S: / 12—
EXPIRATION
EXPIRATION DATE G 2 -
DATE ISSUED ^ �S+ 90-
L
By
,Administrative Authority
TELEPHONE: (619) 564-2246-^:_.