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1611.IWith proper validation C Q' this formtconstltutes an encroachment permit' CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)�� oF TRg� 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 i Subdivision Improvement Permit — Class III DATE: November 20, 1992 Minor Improvement Permit Class IV h LOCATION OF CONSTRUCTION 53-920 Ave. Navarro ' Lq Quinta, CA (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveway Approach DESCRIPTION OF CONSTRUCTION Same > > !_WWENSION OF INSTALLATION OR REMOVAL v A zu Sketch (attach constructionlans if a Z p appropriate) eR� a( U ��,s, • SIZE OF EXCAVATION, IF NEEDED 6X 20 » S 5A H 33QiA�T1©—:92 14 APPROXIMATE TIME WHEN WORK WILL BEGIN 11/20/92 a APPROXIMATE TIME OF COMPLETION 11/27/92 I ESTIMATED CONSTRUCTION COST $ 300 ' (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 advan a of the time when work will be started. Comply with all applicable City Ordinances, the terms and conditions' the per it and all applicab a rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as t e res It of s o k. Signature bf Applicant or Agent o David Ross Miller P.O. Box 72\2564=-5823 Name of Applicant (please print) Business Address Telephone No., Pacific Tradew Dame Same Name of Contractor and Job Foreman '` Business Address Telephone No. 1955 Contractor's License',No. City Business License No. s , 178196-97 ' 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 I" Inspection Fee $ 20.00 PERMIT VALIDATION 10.00 ` Permit Fee PERMIT NO. 1611 Penalty' Cash Deposit Surety Bond DATE APPROVED 11/20/92 if required 21/27/92 k q EXPIRATION DATE I' TOTAL: $ --'30.00 Receipt No. Received by Date Recorded by DAT ISSUED 1/20/92 .,. By. r• aministrative Authority TELEPHONE: (619) 564-2246 NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit 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 I Subdivision Improvement Permit — Class III DATE: Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION `�1470 C - N 0'0 44?—,f L 9 L (Street addresi,or Description of Location) PURPOSE OF CONSTRUCTION V, Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION -- S "` DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED (o �c Zd APPROXIMATE TJMf WHE WORK WILL BEGIN III Izo19v APPROXIMATE TIME OF COMPLETION t I—) I< - ESTIMATED ESTIMATED CONSTRUCTION COST $ - 3/-)0 (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 fiance of the time when work will be started. Comply with all applicable City Ordinances, the terms and conditions of th errnit nil all applicable rules and regulations of the City of La Quints and to pay for any additional replacement necessary as the sult this work. S Signature of Applicant or Agent DZ\�) s5 �� \, �L �' D � E3� 1 -2 ----- N e of Applicant (please print) Business Address Telephone No. Nam of Contractor and Job Foreman Business Address / Telephone No. Contractor's License No. City Business License No. Sgrv"CL I � X19 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 II Recorded by PERMIT VALIDATION Sys �-3 13�F� PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE: (619) 564-2246