1594WlihApropdr valitlation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
w
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: November 4, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-791 Obregon
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway
DESCRIPTION OF CONSTRUCTION
DIMENSION OF -INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 11-4-92
Sketch (attach construction plans if appropriate)
Per Riverside Cnty. Std. # 207
copy attached
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 300`
(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, it 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
,La4Quinta and, to pay for any additional replacement necessary as the result of this work.
f
Signature of Applicant or Agent '
Syierdon Development Corp. 74 -*940 fty 111 564-6929
Name of Applicant (please print) Business Address Telephone No.
SAM DAvi4 Ketrick sm
Name of Contractor and Job Foreman Business Address Telephone No.
337400
Contractor's License No.
Accord
2419
City Business License No.
GLS 348446
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class 111
Public improvements: 3% of estimated construction costs �10CA§R ���b���g_�� 30.000
Private improvements: 3% of estimated construction costs
Minor Improvement 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 NO.
1594
PERMIT VALIDATION
1594
DATE APPROVED 11-4-92
11-13-92
EXPIRATION DATE
DATE ISSUED 11-4-92
By
Administrative Authority
TELEPHONE: (619) 564-2246
4-
t. r
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. _k '� ^�Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION�r e,) //t )
wucut duure33 or uescrlptlon Of Location) )
PURPOSE OF CONSTRUCTION sDRI UEN , A T
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
�I V iffi� I .Dfe— S—Q
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ Q
(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 Ouinta and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
Name of Applicant (please print)
0 .4 f m MI5 74 /G
Name of Contractor and Job Foreman
L13 74 C) O
Contractor's License No.
Business
'W7- -(P i
Telephone No.
Business Address Telephone No.
�.2 /47
City Business License 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 $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ � (]
Receipt No.
Received by Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Recorded by �I TELEPHONE: (619) 564-2246
1 1),86
Administrative Authority