1529NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT Rl
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 II I
DATE: September 1, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-840 Avenida Vallejo
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
PER RIVERSIDE COUNTY STD. NO. 207,
ATTACHED. '
SIZE OF EXCAVATION, IF NEEDED. ,
APPROXIMATE TIME WHEN WORK WILL BEGIN 9/1/92� istAM•19DITR119TPI.-92 34.,00 i4
APPROXIMATE TIME OF COMPLETION 9/2/92
ESTIMATED,CONSTRUCTION COST $ 150.00
(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:
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.
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.
Kenneth .C. Cokeley
Si
re of Applicant qlAgent
P.O. Box 5181-245
75
Name of Applicant (please print) Business Address Telephone No.
Jessie Garcia
Name of Contractor and Job Foreman Business Address Telephone No.
Owner Builder
Contractor's License No. City Business License No.
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
Recorded by
Date°.
PERMIT VALIDATION
PERMIT NO. 1529
DATE APPROVED 9/1/92 ,
EXPIRATION DATE 9/5/92
9/92
DATE I ' UED
Administrative Autho itq
TELEPHONE: (619) 56.4-2246
rn"
T
r
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:�//
Z
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
/ e
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ no
'(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:
Sketch (attach construction plans if appropriate)
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.
of Applicaryf or Agent
Name of Applicant (please print) Business Addr ss Telephone No.
v��-
Name of Contractor and Job Foreman Business Address Telephone No.
o0 Re -n_, G1 U � ISD A
tractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class Ill
Public improvements: 3% of estimated construction costs fy i
Private improvements: 3% of estimated construction costs W 1
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
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246