1501s
With proper validation
r this form constitutes an
-7"e croachment permit
CITY OF+ LA QUINTA
APPLICATION FOR 'PERMIT
I 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
DATE: July 31M 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-680 Rubio
i
,(Street address or Description of Location)
PURPOSE OF CONSTRUCTION - D1rI;17eway approach Sketch (attach construction plans if appropriate)
s
DESCRIPTION OF CONSTRUCTION $FI$ ATTACH$D R1:VL►RWIDS COUNTY STD. NO.
207, ATTACBBD.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
y APPROXIMATE TIME WHEN WORK WILL BEGIN 7/31/92
APPROXIMATE TIME OF COMPLETION 7/31/92 f s•
_ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In cons ideration ;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.
I 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 y p `
pay .for an additional re lacement necessary as the result of this work.
Signature of Applicant or Agent •-
r carry. Doaoho -Sent crg= Gozp. $2-740 Alvarado 5644231
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
'627265, 2154
Contractor's'License No.' . City Business License No.
State hWd -' 1270495 Exp. 1.1/92
r Applicant's Insurance Company Policy Number
FEES: . Subdivision Improvement Permit — Class III 0 10
,�
j4 Public improvements: 3% of estimated construction costs
-Private improvements: 3% of estimated construction costs =
II Minor. Improvement Permit — Class IV: See attached schedule.1501
Inspection Fee $ 20.00 PERMIT VALIDATION
Permit Fee • 10.00 1501
t
PERMIT NO.
Penalty ED 7/31/92
DATE APPROV
Cash Deposit -Surety Bond.
if required 1 1.
EXPIRATION DATE 818/92
fY TOTAL: • * $ . 3.0.00 -
DATE ISSU • D 7431/92
Receipt No. y'
By r'
Received by Date f ... `� Administrative A`b#ho�'ity
Recorded by TELEPHONE: (6191564-2246 `
P
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
DATE
LOCATION OF CONSTRUCTION
(Street
(Street address or Description of Location)
0 -
r
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 1
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.
444zoi 02R.G
me of Appli qnt (please prin
Signature of Applicant or Agent
Business Address
Telephone No.
6/
Name of ontractor and Job For Business Address Telephone No.
D -? z, ZS
Contractor's icense No. Z_7City Business License No. !^ 2-
1
Applicant's Insurance Company Policy Number
FEES:'
�t Subdivision Improvement Permit —Class III
�. Public improvements: 3% of estimated construction costs ;
I Privateimprovements: 3% of estimated construction costs 1 v U y
;*"Minor Improvement Permit — Class IV: See attached schedule
Inspectio6,Fee
Permit Fee
Penalty
Cash Deposit -Surety
if required
r�
TOTAL: it
Receipt No.
Received by Date
$ ?4-
. c.' /
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246