1497NOTE:
With,proper validation i Q'
o
this form constitutes an CITY OF LA QUINTA o
encroachment permit ;
APPLICATION FOR PERMIT _
w 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
DATE: July 29, 1992
LOCATION OF CONSTRUCTION 54-555 Ave Obregon
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach
DESCRIPTION OF CONSTRUCTION Same
DIMENSION OF INSTALLATION OR REMOVAL 22 X 6
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 7129,192
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
PER RIVERSIDE COUNTY STD. NO. 207,
ATTACHED.
ppp ii ii qqgg po �
10518 AS i`TQTALT 3U -.0013
APPROXIMATE TIME OF COMPLETION g dAVR I
.
ESTIMATED CONSTRUCTION COST $ 250.00
(Including removal of all obstruction, materials, and debris, backfilling, com- N
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrye�#o0�
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 a iontnd arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work u�nd rtaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty' our (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinance1placement
the'te ms and conditions Se per i and all applicable rules and regulations o e City of
La Quinta and to pay for any additionil necessary as th reZ
wor 4�
��5s V .
Signature of N.P4
licant or Agent
David '�Oss Miller P.O.-Box 722 La Quints, CA 92253
Name of Applicant (please print) Business Address-OTelephone No.N- _
Pacific Trades Same 564-5823
Name of Contractor and Job Foreman Business Address Telephone No.
B425381 1955
Contractor's License No. City Business License No.
Farmers Insurance 99 12694 55 91
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 $ 20.00
Permit Fee .10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
1497
PERMIT VALIDATION
PERMIT NO. 1497
DATE APPROVED 7/29/92
EXPIRATION DATE 8/7/92
DATE SUE 7/2902
Administrative Authority
TELEPHONE: (619) 564-2246
i;
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' �, _
-
1
�..
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
.2 1.v Subdivision Improvement Permit — Class III
DATE: 1 6 �® Minor Improvement Permit Class IV
�
LOCATION OF CONSTRUCTION J7 ss� "t60j
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Wk'k-)ki AfP"tel Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION ��k trt�, �bv i Cr --
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ el
(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 permitPd all applicable rules and regulations f the City of
La Quints and to pay for any additional replacement necessary as the esult of th` or
Signature of Applicant or Agent
N e of Applicant (please print) Business Address Telephone No.
kc,C;� s 1% y-s� 0
Name of Contractor and Job Foreman Business Address Telephone No.
Contracw's License No. City Business License No.
f#rVtb7_S ZIA6 �lg 1Z6 94 S's 9 �—
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ z o
Rece ived pby Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUEDZZ Z
By
TELEPHONE: (619) 564-2246
1389
Administrative Authority