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1601'i (/,NOTE: OQth proper validation » this form constitutes an encroachment permit . I I� 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 : DATE: Noyembilillr 12r 1992 Minor -Improvement Permit Class IV LOCATION OF CONSTRUCTION 53-750"Avenida Nubio - = (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveway -Approach ' Sketch (attach construction plans if a • p ppropriate) • DESCRIPTION OF CONSTRUCTION Pir Riverside; County Sri #207 (,Attached) DIMENSION OF INSTALLATION OR REMOVAL f-1g� 1g ��- 2-94 t;A TUT 10.00 i4 SIZE OF EXCAVATION, IF NEEDED f APPROXIMATE TIME WHEN WORK WILL BEGIN 11/12/92 APPROXIMATE TIME OF COMPLETION 11/16/92 , ESTIMATED�CONSTRUCTION COST $ (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 an 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 f this work. ` t P ' Signature of Applicant or�Agey(t Michael- J. Trent iw,/ .564-2197 Name of Applicant (please print) _ Business Address Telephone No. TR Noye Construction 74-894 l,enoon Place palm Desert, CA 92260 .341-7942 Name of Contractor and Job Foreman Business Address Telephone No. 516770 2518. Contractor's License No. City Business License No. w State Fund 1154142 Applicant's Insurance Company L Policy Number FEES: Subdivision Improvement Permit`— Class I II r Public improvements: 3% of estimated construction costs - Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ 20,00 Permit Fee1)•QQ Penalty Cash Deposit -Surety. Bond " if required _ TOTAL: ` $ 30.001 ` Receipt No. Received by Date Recorded by ` 1,60 1 ` PERMIT VALIDATION PERMIT NO. DATE APPROVED "11/12/9$ EXPIRATION DATE 1,1/16/92 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 DATE: LOCATION OF CONSTRUCTION Y L (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED - Subdivision Improvement Permit - Class III \ Min r Improvement Permit Class IV LJ /9 CJ C c U APPROXIMATE TIME WHEN WORK WILL BEGIN---/-//*,---;, y ,— Sketch (attach construction plans if appropriate) �t'CfZ j!,v&gC LPA G.. <Erco -?,o-7 tk"TZ.a c Leo APPROXIMATE TIME OF COMPLETION,"" 1 -'CL-) ESTIMATED CONSTRUCTION COST $ (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: Inderrinify,•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. �1 A :LkX)E_L J �- �— Signature of Applicant -Z t g `7 Name of Applicant (please print) Business Address - Telephone No. /�� o t C` o C_j `� .4 7Li- a 5,fZ €� 2 2 I a , ,3 I — -? 4 2 Name of Contractor and Job Foreman Business Address Telephone No. 4 516-,,77c� Contract is Li ense No. Clty�usiness 7nse fro. �i 2 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: 10 $ 30 Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. /(001 DATE APPROVED I (-( 2 --q z - EXPIRATION DATE _ Z-0- 12 - DATE -ISSUED ZDATE.ISSUED By Administrative Authority TELEPHONE: (619) 564-2246