1474With 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
June 240 1992 Subdivision Improvement Permit — Class II I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION, 53-075 Ave. Herrera
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway a panaion Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION flat concrete
DIMENSION OF INSTALLATION OR REMOVAL 281 X 241 � �' ArMCl* EP at 704
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK•WILL BEGIN 6/25/92
APPROXIMATE TIME OF COMPLETION 7/15/92
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 ail 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.
` Signatur rof Applicant or Agent
Mark. Baker 53075 Ave. Herrera � 564-5452
Name of Applicant (please print) Business Address Telephone No.
Owner/Builder
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
State Farm
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
20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 30.00
Date
op0p 11 r
S05iS ASH 06- TAL 4-92 30.0010
14,74,
PERMIT VALIDATION
PERMIT NO. 1474
DATE APPROVED 6/24/92
EXPIRATION DATE 7/20/92
DATE ISS RDDJ/%,/,�.,, 6/24/92
By ,X.!!ll ..
—'Administrative Authority
J
TELEPHONE: (619) 564-2246
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NOTE:
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 other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class I I I
DATE: / ' // Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION CD 7S vl�- #,5�JZiZ A
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION +�'o`� +�X�Ji�s�a� Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 1EEL-AJ-
DIMENSION OF INSTALLATION OR- 6V*L- a8� x c� v
SIZE OF EXCAVATION, IF NEEDED"
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 7—/S`-9.
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.
Sig ture of Applicant or Agent
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. t City Business License No.
P4
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
1386
Administrative Authority
June 26, 1992
AMENDMENT
Aplication for Permit
Public Works Construction
(Encroachment)
Permit tt1474
53075 Ave. Herrera
I am petitioning for a variance to the City's grade specifications with in the City's 12' right-of-way.
As the property owner, I understand at any future date if and when a sidewalk might be installed, that
I will regrade my property to required grade specifications so as to align with the sidewalk within the
City's 12' right-of-way.
�rd-
53075
M k TBakeAve. Herrera
La Quinta, CA
619-564-5452