1568r"1 '
"NOTE:'
!Vith proper validation
'this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT'
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
- i
'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
4
Subdivision Improvement Permit — Class III
DATE: -October 5, 1992 Minor Improvement Permit Class IV
'LOCATION OF CONSTRUCTION 53470 Mad°ro
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION, DriveKay Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION - ' Per
rtUhe jlde County Std. 207
DIMENSION OFASTALLATION OR REMOVAL
SIZE OF: EXCAVATION, IF NEEDED `
` APPROXIMATE TIME WHEN WORK.WILL BEGIN 10/5/92
I .APPROXIMATE TIME OF COMPLETION 10/8/92
ESTIMATED CONSTRUCTION COST $ 300 '
.(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 of this pe'rmii, the applicant hereby agrees to:t J
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
L,a,Quinta and to pay for any additional replacement necessary as the result of this work. • r'
Signature of Applicant or Agent
General Construction Managsmsat, 41-865 Boardwalk #112 Palin Desert, CA 340-4445
Name of Applicant (please print) Business Address ,. `� Telephone No.
Name of Contractor and Job ForemanBusiness Address Telephone No.
On 3114 - On File �.
Contractor's License No. City Business License No.
On,Vile On Pile
Applicant's Insurance Company Policy Number
• k
FEES: Subdivision Improvement Permit = Cla•ss III ,113 _ 5-92 10
AAi�Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
'Minor,lmprovement 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 Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1368
DATE APPROVED 10/5/92
EXPIRATION DATE 10/8/92
DATE ISSUED 10/5/92
By
Administrative Authority
TELEPHONE: (619) 564-2246
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: �b �Z Subdivision Improvement Permit —Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION �`� Ovio� Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION rl
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
�S� 4 2
APPROXIMATE TIME OF COMPLETION l
ESTIMATED CONSTRUCTION COST $ SOU
(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.
,/ Signature of Applicant or Agent,
fi�c.P c G
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman ' Business Address Q Telephone No.
4
Contractor's License No. City, Business License No.
--� e,•�+v� � � �,o �,�- $fid �C�',q
Applicant's Irlsurance 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
Recorded by
1386
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246