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1574NOTE. - With proper validation this form constitutes an CITY OF LA QUINTA v encroachment permit '1. 5 APPLICATION FOR PERMIT Y' PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) "n�w�� !,F S 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 Improvement Permit— Class III j DATE: October 13. 1992 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 53-140 Ave. Carranza and 53-900 Ane' Carran$a` (Street address or Description of Location) L PURPOSE OF CONSTRUCTION' AYiVeMay n9projich, -Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTIONly SER RIVERSIDE COMMt STA. NO. 207, ATTACHED. DIMENSION -OF INSTALLATION OR REMOVAL 21' SIZE OF EXCAVATION, IF NEEDED 1$n X Zan APPROXIMATE TIME WHEN WORK WILL BEGIN 10/13/92 - f APPROXIMATE TIME OF COMPLETION- 16/20192 r ESTIMATED'CONSTRUCTION COST $' 600.00 (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) Of -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 a's'a proximate result`of -any work undertaken under the permit granted pursuant to this application. S' 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 r r La Quinta and to -pay for any additional replacement. necessary as the result of this work. .,. ' i• f T Sign ,uxe of Applicant or Agent -1 -0-410—& •V.....:..«...r sCA • _ ti-♦—.._ n� rte • eist •' - Name of•Applicant (please print) Business Address r Telephone No. - ' Michael . Bangerter , II''� 'Name of"Contractor and Job Foreman - 'Business Address - Telephone No. II { 524325 - t r 1235 Contractor's License No. City Business License No. on Pil4i , 'I Applicant's Insurance Company - Policy Number FEES: . Subdivision Improvement Permit — Class I I I - ., o ,Public improvements: 3/0 of estimated construction costs 10 . AS X0:00•. . ' Private, improvements: 3% of estimated construction costs Minor Improvement Permit —Class IV: See attached schedule 4" 1 •f4 Inspection Fee $ 40.00. PERMIT VALIDATION Permit Fee 10.00' ,. PERMIT NO. 154 'Penalty _ Cash Deposit -Surety Bond - ; f DATE APPROVED 10/13/92 if required EXPIRATION DATE 10/23/92 ` TOTAL:.. $ '50.00 t DATE IIS9U; ED 10/13/92 Receipt No.�( f 1(x Received by Date By MM Administrative Authority Recorded by -_ . 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 Subdivision Improvement Permit — Class I I I DATE: ��— /� z AMinor Improvement Permit Class IV LOCATION OF CONSTRUCTION _�' /�/6 /2�f-x/`z�4 c �3�1C�yl �f-p-rizZ�1. (Street address or Description of Location) /1 PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION Agoayc-L -g,-S DIMENSION OF INSTALLATION OR REMOVAL -7—/ �A SIZE OF EXCAVATION, IF NEEDED '' X 2y`� APPROXIMATE TIME WHEN WORK WILL BEGIN 42 /3 -9Z APPROXIMATE TIME OF COMPLETION ©:�U — 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: Sketch (attach construction plans if appropriate) . z4> 7 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. of Applicant (please print) Name of Contractor and Job Foreman Contractor's License No. Signature of Applicant or Agent Business _5�z/_/ Telephone No. Business Address Telephone No. City Business License No. Applicant's Insurance. Company Policy Number FEES: Subdivision Improvement Permit— Class I I 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 $ U �� Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. lb• Received by Date Recorded by PERMIT VALIDATION PERMIT NO. l S J DATE APPROVED EXPIRATION DATE DATE ISSUED By TELEPHONE: (619) 564-2246 Administrative Authority