1446NOT
F,
With proper validation
ti -th-is 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: May 22, 1992 Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-124. Avenida Carranza
(Street address or Description of Location) '
PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTIONiOF CONSTRUCTION Aamiaeh Per Riverside County Std. No. 207,
-` attached.'
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED,,,6' X 22 X "6" 001182 ,i0 0 9 2`^92 i4
i A GASH i �T��A� i 30.00
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/22/92
` M
APPR X
O I ATE TIME OF COMPLETION
,5•/26j92
r
ESTIMATED CONSTRUCTION COST $ 300,00
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/o�. 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_„tor, 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 pplicable 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 -Applicant or Agent
General Contract Management P.O. Bos 59 564-1486.
Name of Applicant (please print) Business Address Telephone•No.
Same ,
Name of Contractor'and Job Foreman Business Address Telephone No.
524325 1235
Contractor's License No. City Business License No.
State -Fund 229-92 Unit'33-88 r
-Applicant's Insurance Company Policy Number
.FEES: Subdivision Improvement Permit — Class]
i Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs --o/144G
Minor Improvement Permit — Class IV: See attached schedule
•
Inspection Fee $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10 - in
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. ' 144
DATE APPROVED 5/22/92
.r
EXPIRATION DATE 5/29/92
DATE ITS EID 5/22/92
By
Administrative Authority
TELEPHONE: (619) 564-2246
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
ni Subdivision Improvement Permit— Class III
DATE: Is 1 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION SX
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
zj Co
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.
Signature of Applicant or Agent
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
�5 SlZS
Contractor's License No. City Business L' a No.
_ 'fig-��
Applicant's Insurance Company r�� �-�C� itAl-1-11c) Policy Numb r ► -T Z, Z_ F -r
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$ 10
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
1ti
$ 11� b
Received by Date
Recorded by `
130`9
PERMIT VALIDATION
PERMIT NO. O y1K
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By '
Administrative Authority
TELEPHONE: (619) 564-2246