1607W h proper. validation ;
this form constitutes an CITY 'OF LA QUINTA 5
encroachment permit — - --- - -• ^t --
APPLICATION FOR , PERMIT
-� PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
41
For the construction of public or private curbs, , drivewa s ;
y 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 I
+ tDATE:' 1`oyftber 18, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78+-766 Trwin. Circle
(Street address or Description of Location) s
PURPOSE OF CONSTRUCTION DV114aay. APPICOACh Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Per uversldt ciunty •Std: #207
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION; IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 11/18/92
APPROXIMATE TIME OF COMPLETION11/23/92 19
ESTIMATED CONSTRUCTION COST $ 430.00 `
(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:
Indemnify, -defend and save the - City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or'Ioss 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. _.
.. r s
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 ru and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of—this work.
Signature of Applicantt or 'Agent y
.t
! Maine G>~im a P.O. SOX 9M L Wint4i, CA 92253 772-4024
z Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman t"'� ` _ Business •Address Telephone No.
619680 �1W , � 2691
Contractor's License,Nb City Business License No. t- `
$ tista Fund 1297996 8/1/93
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 $ 20-00
Permit Fee 10*00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
PERMIT NO.
1--607-
PERMIT
607•
PERMIT VALIDATION
160.7
DATE APPROVED 11/18/92
EXPIRATION DATE 11/23/92
DATE ISSUED 11/18/92
By C
Administrative Authority
TELEPHONE: (619) 564-2246
6�
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
Subdivision Improvement Permit — Class III
DATE:_ — —'q' Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION - y76 — —7 N iZGCrL,
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MIOGU--�AY APPROC R 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
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 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 appli le rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the esult of this work.
Signature of Applicantor gent
R -7 7 (I R - `77a - g60)141
Name of Applicant (please print) Business Address Telephone No.
TiL_n i Kir. 70 f3OX. 7-2 (ol 9 -7.7 46 D�
Name of Contractor and Job Foreman Business Address Telephone No.
CvtriC'�3� z�L7
Contractor's License No. City Business License No.
�TwTG191J17, �2q�9c1 bJ "(
Applicants 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 • $
Permit Fee
Penalty
Cash biposit-Surety Bond
if required
TOTAL:
Receipt No.
Received by Date
Recorded by
10 C, j
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246