1559NOTE: i
With.proper validation �� 2
this form constitutes an it t hCITY OF' LA-QUINTA
encroachment permS
I; ° APPLICATION FOR PERMIT
t •.
" •� ..PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OF
! 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
'4 DATE: =Sf0teTftUV 25. 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-345. 0breaon and 53-660 Cortise
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION •.iyivouay .a!►pproaCh Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
- M 11VI SIDE .COMM STD. NO: 207,
' ATA=D •
• . DIMENSION OF INSTALLATION OR REMOVAL ;
E' SIZE OF.EXCAVATION, IF -NEEDED
4
r' .APPROXIMATE TIME WHEN WORK WILL BEGIN • 9%25/92.
'APPROXIMATE"TIME OF COMPLETION, MOM
ESTIMATED CONSTRUCTION COST $ 200000 � -.•
(Including removal'of,all obstruction, materials, and debris, backfilling, com-
paction
om
paction and placing permanent. resurfacing and/or replacing improvements)
'In consideration of the granting o1 +
f..this permit, the applicant hereby agrees to:
I f Indemnify,•defend and.save the City, -its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss result1 1. .om'claims or court action andfarising 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 Quints and to pay for' any, additional replacement necessary,as the result of this work. ^
Signature of Applicant orAgent
'4 EXPOetatic 40"truct"lay P.0. 46Z •1547. 1A Quinta, CA-�� $04-2159
Name of Applicant (please print) 'Business Address Telephone No.
i Name of Contractor and Job Foreman Business Address Telephone No.
188236 0120
F Contractor's License No. City Business License No.
State tuild 1242686-9Z
Applicant's. Insurance Company . Policy Number
FEES: , Subdivision Improvement Permit - Class I I I .
o . , • Ig A ��4' � �' � 9z 50 00 #'
Public improvements: 3/0 of estimated construction costs
Private improvements: 3% of estimated construction costs,
+'Minor,lmprovement Permit — Class IV: See attached schedule
-.Inspection.Fee ` $ 40.00 PERMIT VALIDATION
PermivFeef _ 10.00 1,559
•.. _ . PERMIT N0. `
Penalty 912/92 ,
Cash Deposit-SuretyBond DATE APPROVED
if required EXPIRATION DATE
TOTAL . $ 50.00 -
DATE ISSUED 9I25I9Z
Receipt No.'
t By
Received,by Date Administrative Authority '
Recorded by TELEPHONE: (619) 564-2246
A !!)
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
Subdivision Improvement Permit — Class I I I
DATE: 7/ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 51� LIS o�/�IP�I90/V
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION D)EI11, � S'' �p� Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION'�i�2
C,6-TIA
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION U,4
ESTIMATED CONSTRUCTION COST $ JE1-12 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
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.
2
Si rof Applicant or Agen
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
VR t3-.Z;23y
Contractor's License No.
Business Address Telephone No.
n 0
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — CIaI I I
ss
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ L-/ C2
Permit Fee 40
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
TELEPHONE: (619) 564-2246
Administrative Authority