1556w�.
r 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
Subdivision Improvement Permit — Class I II
DATE: Septatabar 30, 1592 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52w990 Avot. O trrwnra
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driytyay 4pproach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 6 $ 20 PER RTVnSIDB COUNTY.S'TD. N0, 207,
ATTACHRD.
DIMENSION OF INSTALLATION OR REMOVAL
r
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 9130192
APPROXIMATE TIME OF COMPLETION 10/7/92
ESTIMATED CONSTRUCTION COST $ 300.00
(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:
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
S happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
I 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 conditioft. f the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the susuit f1 has—work.
L
3
. I
Signature •f Applicant or Agent
David Rose M1101: P.O. Box 722 1a Qu4nt:as CA 92253 564-5823
Name of Applicant (please print) Business Address Telephone No.
Pacific Trades same
Name of Contractor and Job Foreman Business Address Telephone No.
8425381 1955
Contractor's License No. City Business License No.
Varmers Insurance F 90956 93°8U
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 20.00
10.00
$ 30.00
Received by Date
,Recorded by
$SifiCAS -TOT107 r L—i-92 30.0pi0
550
PERMIT VALIDATION
PERMIT NO. 1556
DATE APPROVED
EXPIRATION DATE
9/30/92
10/?0092
DATE ISSUE 9/30/92
By
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE: '
With proper validation
this form constitutes an
encroachment permit CITY OF LA.' QUINTAL
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
3� 9 Z Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Z ` A J� C14�1R
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION - `-��`� Ar 04c -K Sketch (attach constructiona lans if
p ppropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL Y 12_.,
SIZE OF EXCAVATION, IF NEEDED 9
APPROXIMATE TIME WHEN WORK WILL BEGIN _-tom 'Tip cin -`j'
APPROXIMATE TIME OF COMPLETION wk <
ESTIMATED CONSTRUCTION COST $ - oa
(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 der the permit ,granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in, ad nce ::th imework will be started.
Comply with all applicable City Ordinances, the terms and conditions of the d II ap Ii le rules a d regulation�f the City f.
La Quinta and to pay for any additional replacement necessary as the suit o this ork -
J Signature of Appli ant or Agent
Nam of Applicant (please print) Business Address Telephone No.
�t}-C.
Name of Contractor and Job Foreman Business Address Telephone No:
Con�ractor's License No. City Business.License No.
Gnq S" L 9 3 S'd
Applicant's Insurance. Company Policy Number .
FEES: Subdivision Improvement Permit - Class 1I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
1?�F'
Minor Improvement Permit — Class IV: See attached schedule,
Inspection Fee $ PERMIT VALIDATION.
Permit Fee II
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$
Receipt No.
Received by Date
Recorded by
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By `
Administrative Authority
TELEPHONE: (619)564-2246