1528NOTE:-
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: August 31, 1:992
LOCATION OF CONSTRUCTION 54-330 Herrera
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class. IV
(Street address or Description of Location)
6
PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION PER RIVERSIDE COUNTY STD. NO. 2070
ATTACHED.
DIMENSION OF INSTALLATION OR REMOVAL
i
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 8/31/92
APPROXIMATE TIME OF COMPLETION 9/4/92
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
I
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."'
Sign�atuurre'°4, pplicant or Agee
Jacques LeFebre Y.O. Sox 2;95 Palm Desert, CA 92260 (510772-2930
Name of Applicant (please print) Business Address Telephone No.
Same r
Name of Contractor and Job Foreman Business Address Telephone No.
N477507 1411 '
Contractor's License No. City Business License No.
State Pund 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 $ 20.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
Received by
10.00
$ 30.00
Date
f(i51'`ASW VI TA6$T �7 30.00 i0
PERMIT VALIDATION
PERMIT NO. 1528
8/31/92
DATE APPROVED
EXPIRATION DATE 9/5/92
DATE ISSU D 8/31/92
By 5cwo
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246