1572NOTE: ;
With proper validation
this form constitutes an '
t' encroachment permit T
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
c ,and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
i t, Subdivision, Improvement Permit — Class III
DATE:
October 8, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-200 Eisenhower
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Curb cut/aVyroach Sketch (attach construction plans if appropriate)
r
DESCRIPTION OF CONSTRUCTION' PER RIVERSIDE COUNTY STD. NO. 207, _
r
ATTACHED.
DIMENSION -OF INSTALLATION OR'REMOVAL 20 iia/ft
SIZE OF EXCAVATION, IF NEEDED
µ' APPROXIMATE TIME WHEN WORK WILL BEGIN 10/8/92
°i APPROXIMATE TIME OF COMPLETION .10/21/92
ESTIMATED CONSTRUCTION COST $ '400.00
' ! (Including removal of all obstruction, materials, and debris:,backfill ing, com- i
paction ,and_ placing permanent. resurfacing and/or replacing improvements)
k: In' consideration of the granting of this permit, the applicant hereby agrees to:
oIndemnify, -defend and save the City, its authorized agents, officers, representatives and'employees, harmless from and against any and all t
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)1 hours in advance of the time when work will be started.
Comply with -all applicable City Ordinances, the teems 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.
oe
` Signa urs of Applicant or Agent
Cornel Construction P.O.'Bou-1238' t 'Minta, Ca 564-4604
Name'of Applicant (please print) r Business Address Telephone No.
Curb 8awiag, Inc. 31255 Ave'Maravi,lla 'Cathedral City, CAF 321-9700
Name of Contractor and Job Foreman Business Address y Telephone No.
-589084t 2095 a
I
ContractorF i' City Business License No.
's License No.,r
'SaPdco 80154260
Applicant's'lnsurance Company r Policy Number
FEES: • Subdivision Improvement.Permit - Class I II. '
-. ., • • Si'g� 5 g - 8.92,-� 10"
Public improvements: 3% of estimated construction, costs - > CATJTti 4 f 3(3«Qa
Private improvements: 3%'of estimated construction costs
Minor Improvement Permit =Class, IV: See attached schedule
� •• ' •
Inspection Fee' .' $ 20.00 `� II PERMIT VALIDATION
Permit Fee 1.0400
Penalty
Cash Deposit -Surety Bond
if required '
` . TOTAL: r
$ 30.00
Receipt No.
Received by Date
Recorded by
PERMIT NO. 1572
DATE APPROVED 10/8/92
'EXPIRATION DATE 10/21/92
DATE I SUED 10/8/92
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: �— / Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION �2-Z00 f tSe)iJW <_/
(Street address or Description of Location) ,Q
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION �jR/ 12{ 1% . (.0
DIMENSION OF INSTALLATION REMOV
�4led a
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN.-
APPROXIMATE
EGIN.
APPROXIMATE TIME OF COMPLETION
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
La Quinta and to pay for any additional replacement necessary as the result of this work—
Name of Applicant (please print)
e- -a"fA 6
Name of Contractor and ob Foreman T
X-7 O
Contract 's License No.
C
Signattire of Applicant or Agent
- O. 16� 123& -
Business Address .
Business Address
of the City of
5bq - q&v 4-(
Telephone No.
(;,F_, e-fe U,� Telephone No.
City BSt I ne ssLicense 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 $ 2 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 3O
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (61.9) 564-2246
11G ,
Administrative Authority