1602f�IOTE:
th proper validation
'this form constitutes an
^'
encroachment permitK
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 III
DATE: November 13, 1992' Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-200 Obregon 1`
1" r (Street address or Description of Location)
{ Driveway Approach
PURPOSE OF CONSTRUCTION Sketch (attach construction plans,if appropriate)
r, Per Riverside County Std. 1207
DESCRIPTION OF CONSTRUCTION
,(attached)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 4
r° APPROXIMATE TIME WHEN WORK WILL BEGIN
11/13/92
A. '; 'PROXIMATE TIME OF COMPLETION 11/28/92 `
`;ESTIMATED CONSTRUCTION COST $ 400.00
'•;;(Including removal of all obstruction, materials, and debris, backfilling, com-
c- ,
paction and placing permanent resurfacing and/or replacing improvements) yy
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
i
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. 1
f
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
William Doran 1224 W. 252 St. Harbor City, CA 90710 (310),534-.;3313
Name of Applicant (please print) Business Address Telephone No.
Owner / Builder
i Name of Contractor and Job Foreman Business Address Telephone No.
N/A N/A
Contractor's License No. City Business License No. r ,
State Farm Insurance 92-887486.4
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I [I 1
3 9` 3UU ,010'
0:Public improvements: 3% of estimated construction costs t48_5"C:'ASH FT3gT
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule 160
Inspection Fee $ 20.00 PERMIT VALIDATION
Permit Fee 1,0.00
PERMIT NO. " 1602
"+
Penalty
Cash Deposit-Surety.Bond A y -
.sr * . •t -
if required
TOTAL: $ 3 0 0 0.
Receipt No. ` r
Received by Date •`�`' yµ
Recorded by •'''
DATE APPROVED ,1.1/13/92
;EXPIRATION DATE. 11/.20/92
+ DATE ISSUED 11/1$/92
• By
• "• '� + ri Administrative Authority-'
?, TELEPHONE:.(619) 564-2246
I/
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA OUINTA
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
s Subdivision Improvement Permit — Class III
DATE: �� } ——� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION L— x8 4 I� �� 8 R/
�ucoi auuress or uescrlpuon of Location)
PURPOSE OF CONSTRUCTION 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 COMPLETION; f Z L
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 any and all
Penalties, liabilities or lou resulting from claims or court action and aiising 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 Quints 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.
%4 O Iii dill � e 9 L>_1 G 0)- f�
ont� ractor's License No.
.?C //6 %fit
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
ti
Recorded by
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
13086
Administrative Authority
1%