1526t
.NOTE-.'.
'
With proper validation
this fo.rm•constitutes an,r
encroachment permit _.
CITY OF LA QUINTA
APPLICATION FOR PERMIT
-� zip
01;�N
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
8-28-92
52-085 Navarro
LOCATION OF CONSTRUCTION
.L
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Install Driveway Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION per riverside Co. Std No. 207
(attached)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN — —
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $28g� Q
(Including removal of all obstruction, materials, and debris, backfilling, com- N5"EAM M-TUTA?l �"9- 30,410. 14,
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, w
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 pay for any additional replacement necessary as the result of this r7.)
la
Signat • e of Applicant or Agent
Larry Donoho on file on file
Name of Applicant (please print) Business Address Telephone No. ,
Name of Contractor and Job Foreman Business Address Telephone No.
om file on file
Contractor's License No. City Business License No.
on file on file
Applicant's Insurance Company Policy Number.
FEES:. Subdivision Improvement Permit — Class I II
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..
$ 20
10
30
$
a,g
Received by Date
11 , f% 6
5,29
PERMIT VALIDATION
PERMIT NO. 1526
8-28-92
DATE APPROVED
EXPIRATION DATE 9-4-92
DATE ISSUED
By
Adknistrative Authority
Recorded by II TELEPHONE: (619) 564-2246
o •
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
DATE:— Subdivision
�/w Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 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 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.
VI Signature of Applicant or Agent
�SIiS /�IA�2i
Name of Applicant (please print) Business Address Telephone No.
ZAgIg ., .a"6ze 90 K eve a/�i14W 32- 2 - 317 !�Z-
Name of Co tractor and Job Foreman Business Address Telephone No.
G ?- -1 '-6 5- -2 f S V
Contractor's License No. City Business License No.
S7 -41L9' ro41 / 270 2`2S
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
Received by Date
Recorded by
1386
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246