1599f
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC -WORKS CONSTRUCTION (ENCROACHMENT)
4
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
r J
PB I. "FAR r'Pd'fhc —1 "p` 30.00
Subdivision Improvement Permit — Class II I
DATE: November 12, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-420 EiseahoVelr
(Street address or Description of Location)
J
PURPOSE OF CONSTRUCTION DriVeMAY Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF„INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 11/12/92
1
APPROXIMATE TIME OF COMPLETION 11/16/92
ESTIMATED CONSTRUCTION COST $ 550.00
(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:
Per Riverside County Std. #207
(Attached)
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.
Signature of Applicant or Aent
Salt &`Pepper Consrate Construction 368 Bork Air Drive Palm Springs, CA 92262 321-1357
Name of Applicant (please print) ' Business Address Telephone No.
Same
Name of Contractor and Job Foreman Business Address, Telephone No.
r .
616475 Up. 3/93 2730 Exp. 12/26/92
Contractor's License No. City Business License No.
� cO' a 0W lli I YA.x 4t
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 1 $ 20.00
Permit Fee } 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ $0.00
Receipt No.
Received by Date
Recorded by
f
PERMIT VALIDATION
PERMIT NO. 1599
DATE APPROVED 11/12/92
EXPIRATION DATE 11/16/92
DATE ISSUED 11/12/92
By
F 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:- ��//z I Z- Subdivision Improvement Permit — Class III
L Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION s2— ��ZO r/SelVAOL,£2
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION I%21vE Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETIONj(4L_L/3/�rZ
ESTIMATED CONSTRUCTION COST $ 6S -
(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.
Name of Applicant
SA n►rn._-,
�_ �£? �_O/vc
,ase print)
Signature of Applicant or Agent V- ";FA k,
/' !�
Business Address
elenhnni- Nn
Name of Contractor and Job Foreman Business Address Telephone No.
01.4-1'?S <44,. �73�
Contractor's License No. City Business License No.
nNNnwni s insurance t,ompany 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
O Q
Inspection Fee $ a 1..7
Permit Fee 10. O c1
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246