1473------------------------
NOTE:,,
_ _ _ _ _ NOTE:,, i
VWiMbroper validation or
this form constitutes an
encroachment permit
CITY OF LA QUINTA
r 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 II I
DATE: --June 23, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION f� 78-735 .Sagebrush
,
t ;
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION ( Drivieway Annr�ach Sketch (attach construction plans
ifif a�
� p ppropriate)
DESCRIPTION OF CONSTRUCTION roncrP_tP
d'.
DIMENSION OF INSTALLATION OR, REMOVAL 16 Feet
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN HAMA 210 1499
Per Riverside County Std. No. 207
.r
APPROXIMATE TIME OF COMPLETION Tune 25;_1992
ESTIMATED CONSTRUCTION COST $ 600.00
(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 adva e of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of thtRermi and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the resulItlk�iwork.
Signature of Applicant or Agent'
Grimes 78-545 Sagebrush La Quiff a, CA 92253 564 -
Name of Applicant (please print) Business Address Telephone No.
Jesse Garcia 82-358 Mountain View Indio, CA 92210
Name of Contractor and Job Foreman Business Address Telephone No.
6187061 2105
lvtw Contractor's License No. City Business License No.
State Workman's Comp 1242868-91
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 costs5ig'' 6 6—''�-42(T3 10
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 20
10
$ 20.00
Received by Date
i8 c l.ASA 1 TQTAL f 30. U0
PERMIT VALIDATION
PERMIT NO. 1473
DATE APPROVED 6/22/92
EXPIRATION DATE .6/25/92
DATE ISSUED 1 6/22/92
By iw
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
t.•
w
'y
.._ ...
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
D&TE:
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTAL,.LATIQN OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
ri
APPROXIMATE TIME OF COMPLETION 3
ESTIMATED CONSTRUCTION COST $ % 0�
(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 �th
he time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the peaall applicable rules end regulations of the City of
La Quints and to pay for any additional replacement necessary as the result of kj
S
Name ofApplicant (pleaseptint)
Naprof Contractor a -M Job Foreman
&
Contractor's License N(L
Signature of
Business Address
Business Address
ica r Agent
Telephone No.
Telephone No.
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 Vo
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 30
Received by , Date
Recorded by
1266
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED G xar a
EXPIRATION DATE
DATE ISSUED
,s
By
Administrative Authority
TELEPHONE: (619) 564-2246 .
w -
NOTE:
With proper validation
this form constitutes an
encroachment permit CITY OF 'LA QUINTA"
APPLICATION FOR PERMIT s
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OF TftH�wS
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: June 23, 1992 Subdivision Improvement Permit - Class III
LOCATION OF CONSTRUCTION 78-735 Sagebrush Minor Improvement Permit Class IV
(Street address or Description of Location) _
PURPOSE OF CONSTRUCTION —Driv wav AP-nrn rh
DESCRIPTION OF CONSTRUCTION Cnn( rP{p
DIMENSION OF INSTALLATION OR REMOVAL 16 Fppr
SIZE OF EXCAVATION, IF NEEDED 1F Fppr
APPROXIMATE TIME WHEN WORK WILL BEGIN ..iiinp 2-3--j-q92.
Sketch (attach construction plans if appropriate)
Per Riverside County Std. No. 207
APPROXIMATE TIME OF COMPLETION- Tnnp 95� 1 qq9
ESTIMATED CONSTRUCTION COST $ 600.00
(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
Notify the Administrative Authority at least twenty-four (24) hours in advNe of igranted
thetimermit ew en work nwill bet to lstarted�tion.
Comply with all applicable City Ordinances, the terms and conditions of ar"i,,;,"�`r. and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the resul f jtnq work,
Bob Grimes
45
Signature of
or Agent
niame or Applicant (please print)
Business. Address Telephone No.
Jesse Garcia 82-358 Mountain -View
Name of Contractor and Job Foreman Indio C 92210
Business Address ss
6187061 Telephone No.
Contractor's License No. 91 f15 '
State Workman's Com City Business License No.
Applicant's Insurance Company 1242 68 -
Policy Number
FEES Subdivision Improvement Permit -Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 2 11 27 -7
i0
Minor Improvement Permit - Class IV: See attached schedule �85S8 A1,Q 96#4'R -1 0.00
Inspection Fee $ 20 II Jtl 1 tl R
Permit Fee
Penalty
Cash Deposit -Surety Bond.
if required
10
TOTAL: $_ 3n. no
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1473
DATE APPROVED'6/22/99
EXPIRATION DATE 6/25/92
DATE ISSUED 6/22/92
By
Administrative Authority
TELEPHONE: (619) 564-2246