1445"0' TE: !
With proper validation 01,
this form constitutes an (6�_
encroachment permit CITY OF L(A QUINTA
APPLICATION FOR
PUBLIC WORKS CONSTRUCTION
f
PERMIT
(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-`'O-CI'ass-lll-", R -
DATE:. May 22. 1992 ' Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION _ 52-810 .Montezuma
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approahh
DESCRIPTION OF CONSTRUCTION Per Attahhed
DIMENSION OF INSTALLATION OR REMOVAL Per Attached
SIZE OF EXCAVATION, IF NEEDED
I
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/20/92
APPROXIMATE TIME OF COMPLETION June 7, 1992
ESTIMATED CONSTRUCTION COST $ 500.00
(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:
Sketch (attach construction plans if appropriate)
Per Riverside County Std. 207
(attached) ..
007682 62S719 2T87A'F_ 92
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 Ciiy of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of pplicant o gent 4
t .
Jeff Shivley P.O. Box 1774 La Quinta, CA 92253 360-2847
Name of Applicant (please print) Business Address r Telephone No.
;Santa Rosa Construction' 74-225 Hwy 111, Suite C fi. 568-0855
Name of Contractor and Job Foreman Business Address Telephone No.
30.00
565814 2001
Contractor's License No. City Business License No.
Carmel Tnaur,ance Agenev_(C.N.A.) 40673375
Applicant's Insurance Company Policy Number f
i
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 $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 30.00
Received by Date
14,45
PERMIT VALIDATION
PERMIT NO. 1445
DATE APPROVED .5/22/92
EXPIRATION DATE 6/7/92
DATE ISSUED
� 5/22/92
By --:;t
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
�`
. ,
1
j NOTE:
With proper validation
this form constitutes an CITY OF L' A QUINTA
I encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
i
C OF
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 -111• -
DATE:_May 22, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-810 Montezutnn
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approahh Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Per Attahhed Per Riverside County Std. 207
(attached)
DIMENSION OF INSTALLATION OR REMOVAL Per Attached
00570 Fl
2 Ip 9?9 : j ,•'2-92
— i0 t,SFI+`'i
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/20/92
APPROXIMATE TIME OF COMPLETION June 7. 1992
ESTIMATED CONSTRUCTION COST $ 500.00
(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.
Signature ofApplicantar<gent
Jeff Shivley P.O. Box 1774 La Quints, CA 92253 360-2847
Name of Applicant (please print) Business Address Telephone No.
Santa Rosa Construction 74-225 Hwy 111, Suite C 568-0855
Name of Contractor and Job Foreman Business Address Telephone No.
565814 2001
Contractor's License No. City Business License No.
Carmel Insurance Agency (C.N.A.)/0673375
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 zv-rt/ ISe,D
Inspection Fee $ 20.00 PERMIT VALIDATION
1 1c
Permit Fee 10.00 1445
PERMIT NO.
Penalty DATE APPROVED 5/22/92
Cash Deposit -Surety Bond
if required EXPIRATION DATE Ca' 1 X19 Z
TOTAL: $ 30.00 5/22/92
DATE ISSUED
Receipt No.
By kz4n-
Received by Date G Administrative Authority
Recorded by 11 TELEPHONE: (619) 564.2246
r^k
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 privatecurbs, 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 III
DATE: 2/l lG Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S'Z—/ilo.y7,=— 40,6
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 7
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN Zo
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:
Sketch (attach construction plans if appropriate)
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 o pplican or Agen
)0,F-1-
DO . ox
1_-Q,
36O-z84*
Name of Applicant (please print)
gusiness Address
Telephone No.
4A,, -tea OE 5,9 Com s �
�4 - Z Z S 14:4
I l 1 5u
06,55
Name of Contractor and Job Foreman
Business Address
Telephone No.
15!jE!5'24-314
90 f
Contractor's License No.
City Business License No.
N5 NG
�,N,�_
O
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.
Received by
Recorded by
Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
138E
Administrative Authority