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