1450M,
OT- E
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
-• J2' M,,. rr r.r .r .. t. ...w,., r. r.w.1/., w ., a. rn...w .N.f .c ..r ... .. `r .-.... x • .e . ...
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
other;like'public-;vvorkswimprovementsrin,,connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
June 3, 1992 Subdivision Improvement Permit — Class I I I
DATE: Minor Improvement Permit Class IV
LOCATION•OF CONSTRUCTION 54-380 Carranza
(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.
4
DIMENSION OF INSTALLATION OR REMOVAL J v�
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6/4/92 ?0518'tASH 1` t& -i3-92 30.0014.
1V •�
APPROXIMATE TIME OF COMPLETION �.
ESTIMATED CONS RUCTIONCOST $ 300.00 t '
,, .
(Including removal• all obstruction, materials, and debr s�backfi.11ing; com-
paction and placing permanent resurfacing and/or ,rep al cing improvements) '
In consideration of the granting of this permit, t/he appl.i_can.t—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 pe it and all applicable *rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result this work.
Signature,of ` ppli nt or Agent
General Construction Management 41-865 Boardwai Palm npr,
Name of Applicant (please print) Business Address Telephone No.
Same
Name of Contractor and Job Foreman Business Address Telephone No..
599424 1918
Contractor's License No. City Business License, No.
California Indemnity P800 826.6A Exp F8/92-
Applicarit'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 $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No
$ 30.00
Received by Date
Recorded by
1450
PERMIT VALIDATION
PERMIT NO. `1450
DATE APPROVED 6/3/92
EXPIRATION DATE 6/5/92
DATE IS UE n 6/3/92
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
C L� Subdivision Improvement Permit — Class II I
DATE: ! _ Minor Improvement Permit Class IV
Of
LOCATION OF CONSTRUCTION �V rdleooe,4AI�A
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION _ ��8w�1 `''� Sketch (attach construction plans if appropriate)
Vr
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
pint IT4,1403s 1oIZ 4o 0317 %TO
-d- 2 07
APPROXIMATE TIME OF COMPLETION 44
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
Un Quinta and to pay for any additional replacement necessary as the result of/fp's work.
enlenvL 64�s;• /,Ia
Pm&v/Signature
(//-s
or
MA
Name of Applicant (please print) Business Address Telephone No.
/CnR�
Name of Contractor and Job Foreman Business Address Telephone No.
.S-Cfggz
Coto License No. j City Business License No. ryI
Applicant's Insurance Company
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
1389
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246