1600I
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
C, ' APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
1'
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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 II
? DATE: November 12, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-195 Navarto
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(Street address or Description of Location)
PURPOSE OF CONSTRUCTION ArlvgyAy Approneh Sketch (attach construction plans if appropriate)
..9ESCRIPTION OF CONSTRUCTION 16' x 20' per Riverside- C9unty Std. #207
(attached)
DIMENSION OF4NSTALLATION OR REMOVAL
r
SIZE OF EXCAVATION, IF NEEDED
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APPROXIMATE TIME WHEN WORK WILL BEGIN 11/12/92
APPROXIMATE TIME OF COMPLETION 11/16/92
ESTIMATED CONSTRUCTION COST $ 400.00 -
(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:
&AI -P-92 30.0014
��
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 prope, rty
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 Agent
Gallien Construction' 52-811 AvenW Villa La Quinta, CAA 92253 564-1187
Name of Applicant (please print) Business Address Telephone No.
14,
Mike Gallien Same
Name of Contractor and Job Foreman Business Address Telephone No.
377184 Exp. 9/30/93 2034 Exp. 12/26/92
Contractor's License No. City Business License No.,
Scottsdale Insurance
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of estimated construction costs
-01
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee 4 $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
$ 30..00
r.
t
TOTAL
Receipt No.
Received by _
Recorded by
20,00
10.00
Date
PERMIT NO
1600
PERMIT VALIDATION
1600
DATE APPROVED
EXPIRATION DATE
11/12/92
11/16/92
DATE ISSUED 11/12/92
By
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
�Z
DATE:-
LOCATION OF CONSTRUCTION
wcreec aaorem or uescription Ot Location)
PURPOSE OF CONSTRUCTION --k o I r o
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 74 x �O
SIZE OF EXCAVATION, IF NEEDED X,,90
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class III
Minor Improvement Prmit Class IV
a VO � "i /q 5 e, - TA
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION h111 912
ESTIMATED CONSTRUCTION COST $ &ye'), O
(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:
111111 c� /� '. `\
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) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
5"77 /ge-f
Contractor's License No. n
*.,?O 3 //
City Business License No
I Z s 1-13�/ l? - (F 7
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 $ Zd
Permit Fee
Penalty
Cash Deposit -Surety Bond
if. required
TOTAL:
Receipt No.
$ 30
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE " Z -a -9Z-
DATE
9Z -
DATE ISSUED (I I Z
By
Administrative Authority
TELEPHONE: (619) 564-2246