1488rN '
With proper validation
this form constitutes an
encroachment permit CITY "OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
L_
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
Jul 13 1992 ``- Subdivision Improvement Permit— Class III
DATE:.July , Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-570. Avenida Diaz
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
SEE RIVERSIDE COUNTY STD. NO. 207,
ATTACHED.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 7/18/92
APPROXIMATE TIME OF COMPLETION 7124/92
ESTIMATED CONSTRUCTION COST $ "600.00.
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and' placing permanent resurfacing and/or replacing improvements)Aa!�4AL2 40 oA7-13-21
In consideration of the granting of this'permit, the applicant hereby agrees to:
A TGTAL30. 013
f
r
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. t
Comply with all applicable City Ordinances, the terms and conditions of the p rmit and all a p11be rul sand regulations of the City of
La Quinta and to pay for any additional replacement necessary as the re of this work.
Signatu a ofe'A'pplicAl or Age t
P.B.A. General Contractors 45-250 Smurr Std. Indio, CA (-3/45-3115
Name of Applicant (please print) Business Address Telephone No.
MB.A.) Victor Pinson
Name of Contractor and Job Foreman Business Address Telephone No.
547897 1469
Contractor's License No. City Business License No.
Sfingi & Hannon Ins. Service PWC C36312543
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 $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1488
DATE APPROVED 7/13/92
EXPIRATION DATE 7/24/92
DATE ISSIED,/ C //13/92
By K=4 _42
Administrati a Awthority
TELEPHONE: (619) 564-2246
7
.-��-���..�-�.•wl�.`��rr.l+ie-.�i1�"-�.-- r�r•_..-.---.- -_err-..... - � ...- � _ _ _- r- - � - -
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
`� \Z Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTIONl�aK-2—
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION GU 1Z Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
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 ail
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.
Signatu a of Applicant o A
Name of Ap Ilcant (please print) `` Business Address Telephone No.
Name of Contractor and Job Foreman
SL�ge>q _�
Contractor's License No.
Business Address Telephone No.
City Business License No.
kcic-�l �' H -."No K 1 lk�S
Applicant's Insurahoe 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
�NO�`
By
Administrative Authority
•TELEPHONE::(619)'564-2246