1576I
w �
DOTE
With proper validation 4 2 t
O
this form constitutes an • o
encroachment -permit CITY OF LA _QUINTA z,
59
APPLICATION FOR PERMIT F r &
PUBLIC WORKS CONSTRUCTION, (ENCROACHMENT)
C� OF Thy
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 '
DATE: October 14, � 1992Minor Improvement Permit Class IV
AI • r,F ;
LOCATION OF CONSTRUCTION'. 78-340=�al=#; La Oginta, CA
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Ozrtewn ADP?cacb Sketch (attach construction plans if appropriate)
i
DESCRIPTION OF CONSTRUCTION Concrete Per >Ltva>cade CpunCl► "$C@.207
DIMENSION OF INSTALLATION ORREMOVAL 61 x 18
' • fly
SIZE OF EXCAVATION„ IF NEEDED NORO,
APPROXIMATE TIME WHEN -WORK WILL BEGIN 10/14/92 AAf�}--j 1-91, 4 "
, Rs 6j6tAi 30.00 .
/92:
APPROXIMATE TIME OF COMPLETION 10/16
j -ESTIMATED CONSTRUCTION COST $
(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.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 f
penalties, liabilities or loss resultingfrom 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 o the permit and W 'cable rules and regulations of the -City of
.:La Quinta and to pay for any additional replacement necessary as the result of his or .
Ig re o pplicant or Agent
William Andaxson P.O. Ooxt 2175 PaI • Dedett, CA 1741140
".Name of Applicant (please print) Business Address ,f Telephone'No.
i� Name of Contractor and Job Foreman f Business Address r' Telephone No.
•460719 SO4 6/30/93- 2554 Exp. 12/31/92
' Contractor's License No.;� ,.�,.��� City Business License No.
Applicant's Insurance Company Policy Number
FEES:. Subdivision Improvement Permit - Class III '
6 1 k, Public improvements: 3%'of estimated construction costs
' Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule 1576
.
t20.00
Inspection Fee $ - PERMIT VALIDATION
r 1576'
Permit Fee' - lo."i, Ott PERMIT N0.
Penalty- 10/14/92
Cash Deposit -Surety Bond~' DATE APPROVED
if required EXPIRATION DATE 10110/02
TOTAL:. $ 30.00 10/14/02
DATE, ISSUED
Receipt No. B J
Y
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
• � 1
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 `� �� Min
provement Permit Class IV
LOCATION OF CONSTRUCT4QN -V c
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
/
DESCRIPTION OF CONSTRUCTION
Sketch (attach construction plans if appropriate) AA
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 'nC?4 �
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION /e:> Vis"' 9 '
ESTIMATED CONSTRUCTION COST $ �� c
(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/hermit a d all apq�l able rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of„this >o�k. /
Wnat re of ApplicVn—t o4Ant
ReDx C-21
Name of plicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
-2is dun . L%3193 a sS y i4 r? �aI3) I
Contractor's License_ N 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 $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ ;
Receipt No. I
Received by Date
Recorded by
1 006 .
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246