1567-
�rIOTE-
C1Vith proper validation
this form constitutes an
encroachment permit
f
CITY OF LA. QUINTA
APPLICATION FOR PERMIT
' d
PUBLIC 'WORKS ;CONSTRUCTION (ENCROACHMENT)
• M
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
1 - - - -
Subdivision'lmpi-overrient Permit — Class I I I '
DATE: October a* 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53.760 Avenida Monteauma
` (Street address or Description of Location) .
PURPOSE OF CONSTRUCTION Driyewaly l"tallatiou Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 'Per Riverside County -Std, 207
(Attached) ,
j DIMENSION O.F INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ' 1220/92
APPROXIMATE TIME, OF COMPLETION 12/25/92
ESTIMATED CONSTRUCTION COST $ 300.00 '
(Including removal of all obstruction, materials; and debris, backfilling, com
paction •and placing permanent resurfacing and/or replacing improvements)
lu
Iii 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,
x ' 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. '
a 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 work.
Signature of Applicant or Agent
Tondral Ccwetructl0i Manageaaent 41-865 Boardwalk ,#112„.Palm;Aeeert 340-4445
Name of Applicant (please print) Business Address Telephone No.
Same.,
"Name of Contractor and Job Foreman Business Address Telephone No.
,.
- On File On. file
' Contractor's License No: „ City Business License No.
r ' On File Oxi. File
Applicant's Insurance Company ,' Policy Number
FEES: Subdivision Improvement Permit —Class III
J f,
i
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
Receipt No.
. Received by
Recorded by
$ , 30.00
Date
j
1851 AjR 1494 TAP -25- 11` 30`. QO 10
.1567.
PERMIT VALIDATION
PERMIT NO. 1567
DATE APPROVED 10/+/92
EXPIRATION DATE 12/25/92
DATE ISSUED 10/5/92
ey ..,�._
Administrative Authority
TELEPHONE: (619) 564-2246
•,i
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: Z Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION s3`��b _Dry ' u�,o &10 < � I. to
(Street address or Description of Location) f�
PURPOSE OF CONSTRUCTION 45�2 i"" �' — �►� �/�J 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 20
APPROXIMATE TIME OF COMPLETION 5 L
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.
Wfd/
Name of Applicant (please print)
Signature of Applicant or Agent
y/ go
Business Address
Telephone No. 33yB-VWj1__
Name of Contractor and Job Foreman Business Address Telephone No.
SS __12 - lS/6�1
Contractor's No. / City Business License No.
,✓ ��r�ti-fS �,�s�r✓ P�oo�G�',�
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
Received by Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Recorded by II TELEPHONE: (619) 564-2246
Administrative Authority