1455N'JTE: 4.
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 oilier like public works improvements inconnectionwith MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class II I
DATE: June 8, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION — 53-865 Avenida Mendoza
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION _Driveway Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Per Yi>Qerside Std. 4E207
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6/9/92
APPROXIMATE TIME OF COMPLETION- 6/12/92
ESTIMATED CONSTRUCTION COST $ 300
(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 toithis application.
Notify the Administrative Authority at least twenty-four (24) hours in advance *of the time
when worhw �nd
�rga
Comply with all applicable City Ordinances, theterms and conditions of the permit and fl ap licable rs of the City of
La Quinta and to pay for any additional replacement necessary as the result of t pis woc. /�
Signa ure of Ji n or Agent
Ken Stemmer 77-745 Delaware Palm Desert, CA 772-0046
Name,pf Applicant (please print) Business Address Telephone No.
Same
Name of Contractor and Job Foreman Business Address Telephone No.
.589937
Contractor's License No.
Farmers Insurance-.•
2119
City. Business License No.
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
Permit Fee 10
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30
Receipt No.
Received by Date
Recorded by
2Hsi'$CAN48 AH�"' 30.00
! 4,5 5
PERMIT VALIDATION
PERMIT NO. 1455
DATE APPROVED 6/8/92
EXPIRATION DATE '6/12/92
DA ISSUED 6/8/92
By
Administrative Authority
TELEPHONE: (619) 564-2246
it
1 11
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
/ _ _ Subdivision Improvement Permit — Class III
DATE: n Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S 3 —��D� U _ fl'UV- C C_C_,A
(Street address or Description of Location) I ,
PURPOSE OF CONSTRUCTION -- i 1 . �� Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL /71
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION — '7
ESTIMATED CONSTRUCTION COST $ so
(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, to or mage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pultuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when ork will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit nd rule d regulations of the City of
La Ouinte and to pay for any additional replacement necessary as the result()if i woA�applicab
or Agent
Name of Applicant (please pprint) Business Address
f Telephone No. r_�
Name of Contractor and Job Foreman Business AddresselepZrie No.
Contractor's License No. City Business License No.
El/ VV VAAZ --.�
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 Date
Recorded by
1236
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246.,. 1 ,.