1480�. _.N6E:
With proper validation
-this form Constitutes an
encroachment permit
For -the construction of .public or private curbs, driveways,'.pavements, sidewalks, parking lots, sewers, water mains
and other like public Works improverrie'nts in connection with.MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
Subdivision Improvement Permit — Class I I I
DATE: Tune 3n. 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Driveway approach 54-290 Cr�rtax
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway spproacll Sketch .(attach constructionlans if appropriate)
ppropriate)
' x
DESCRIPTION OF CONSTRUCTION. -Per Riverside County std. No. •207,
• attach@d': _,
DIMENSION OF INSTALLATION OR REMOVAL'
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6/30/92
' APPROXIMATE TIME OF COMPLETIO7 110/92
ESTIMATED CONSTRUCTION COST $ '
(Including yemoval-of all obstruction, materials, and debris, backfilling, com-
paction and placing perm anent. resurfacing and/or replacing improvements)
In consideration of.the`.granting of, this permit, the applicant hereby, agrees to:
4
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. F'
Comply with all applicable City Ordinances, the terms and •conditions of the permit a745 all applicable rules and regulations of,the City of
La Quirita and to pay for any additional replacement necessary as the result of t ork.
• Signature of Ap I•lcant or Agent
Stark ConAtuction Co. Inc. 39-7.25 GaYend Ste. E, Palin Desert, CA 92260 345-9711
Name of Applicant (please print) Business Address Telephone No. J
SatnA •
Name of Contractor and Job Foreman , ''Business Address Telephone No.
"
577776 �• � • 790
Contractor's License No. City Business License No.. F r
StAts Fuad. ; 4581140
Applicant's Insurance Company ++� Policy Number
FEES: Subdivision Improvement Permit — Class 111`' po0g� iioo 07 0.92 i0
Public improvements: 3% of,estimated construction+ costs g
AF. 30.00
Private .improvements: 3% of estimated construction costs 1 480...
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00 PERMIT VALIDATION
Permit Fee 10.00 PERMIT NO. 1480 1
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 30.00
Received by Date
Recorded by
DATE APPROVED 6/30/92 t
EXPIRATION DATE 7/10/2. '
DATE S ED6/30/92
gy
Administrate ority
TELEPHONE: (619) 564-2246
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 III
hDATE: c 7 Z_ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION DLILC ,4 F'PAL4-C17`-
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
AT --r,9 c ---r o
APPROXIMATE TIME OF COMPLETION D Z
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 licant or Agent
��/`��lC COBS/� �% Tit/C. 3�1-7� �i'f�2�•cr/��rE 3 15���—r 7l/
Name of Applicant (please print) Business Address Telephone No.
5A --.c 54-,j --
Name of Contractor and Job Foreman Business Address Telephone No.
6-7777
Contractor's License No.. City Business License No.
r-ce"g e -1s,55, / y a
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
Recorded by
$ 3-15 .
Date
PERMIT VALIDATION
PERMIT NO. 1yg�
DATE APPROVED
EXPIRATION DATE `7
DATE ISSUED �✓��'
By
TELEPHONE: (619) 564-2246
1386
Administrative Authority