1577'With proper validation 4 Q'
this form constitutes an CITY. OF 'LA QUINTA
encroachment permit
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
DATE: OctObhr IS, 1447 Minor Improvement Permit Class'IV
LOCATION OF CONSTRUCTION. (0AU'1JL me 7"'� �. i�
(Street address or Description of Location)-
PURPOSE
ocation) PURPOSE OF,CONSTRUCTION PrIVVAVAV ADVrartch Sketch (attach construction plans if appropriate)
DESCRIPTION OFCONSTRUCTION
PIM UVBRSIM CNIM STD. 140. 2,07'.
DIMENSION OF INSTALLATION OR REMOVAL 16 Feet wide t'
driyowaiy . .
SIZE OF EXCAVATION, IF NEEDED
s
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION On* 'day A ; �•
ESTIMATED CONSTRUCTION COST $ 15000'
g. (Including removal of all obstruction; materials, and debris, backfilling, com
paction and placing permanent resurfacing and/or replacing,improvements) '
Inconsideration 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 -c ourt action and arising out of any accident, loss or damage to persons or property "1
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 ar&to pay for any additional'. replacement'necessary as the result of this work. "
' Sig ture of Applicant or Agent
$axes C. Castimaa. 77-100 Minin: Ave Palm'Dealert, �A 345.5430
Name of Applicant (please print) Business Address • Telephone No. .
. Name of Contractor and Job Foreman Business Address Telephone No.
�n AS 195333- � � � 2578
' Contractor's License No. City Business License No.
84610" ism's-ago�`� 't e:. Tl>��/!1 SvIC[!a f3[t. Q S "'..i"�ei `' i ! I G •"
Applicant's Insurance Company [a���, Policy Number
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of est imated. construction' costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit.— Class IV: See attached schedule
k.
Inspection Fee $ 20.00
Permit Fee 10'400 •
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00• +
Receipt No.
Received by Date
Recorded by
5#B sH f 1jarAe-15-92 30.00 i4
1•wi..t7
PERMIT VALIDATION
1577
PERMIT NO.
10/15/92
DATE APPROVED
EXPIRATION DATE
10/22/92
10/1$/92
n ATF lqqt]Fr)
By -4
/
Administrative Authority
TELEPHONE: (619) 564-2246
3 'l
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 II I
DATE:
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION _ �Z— 15&C O'/erl�O�Lt,
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION _i /IVW4T V /P�'oac�i
, Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
i•
DIMENSION OF INSTALLAT104 OR PEMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION e
ESTIMATED CONSTRUCTION COST $ ASO vc
(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.
,
,�qature of Applicant
or Agent
P. S G . C:cZs�l�lq`l i %%—ZOrJ /ti% tirr fid/-�
Name of Applicant (please print)
Name of Contractor and Job Foreman
Contractor's License No.
/__,-v n 6�7 r-
Business Address
Telephone'No.
-Business Address � Telephone No.
I
City Business License No. (?
Applicant's Insurance Company olicy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs F�
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
PERMIT VALIDATION
Permit Fee
PERMIT NO.
Penalty I
Cash Deposit -Surety Bond ' DATE APPROVED.
if required `EXPIRATION DATE
(
TOTAL: $
DATE ISSUED
Receipt No.
By
Received by Date Administrative Authority .
Recorded by TELEPHONE: (619).564-2246
r