1616•.r
NOTE: _.
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS" CONSTRUCTION (ENCROACHMENT)(, P -
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 II I
DATE: 12--1-92 , - Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-400 Villa
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driyewy Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Driveway Approach $hall Be installed
Per Riverside Co. Std. No. 207
( Attached)
DIMENSION -OF INSTALLATION OR REMOVAL
. r
SIZE OF EXCAVATION, IF NEEDED F
APPROXIMATE TIME WHEN WORK WILL BEGIN 12-1-92
APPROXIMATE TIME OF COMPLETION 12-6-92
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 any and all
r
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 perF"riit and all applicable rul s and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result Al this wor .
Signature of Applicant or Agen�tt
Sterling des P.O. Box 450 La Quiata - CA 92253 564-1866
Name of Applicant (please print) „Business Address Telephone No.
Name of Contractor and Job Foreman ' Business Address Telephone No.
B 638535 859 M
Contractor's License No. City Business License No.
on file - �,' on file
Applicant's 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 $ 20
Permit Fee 10 II
Penalty ,
Cash Deposit -Surety Bond
if required
,
TOTAL: $ 30 •
Receipt No.
Received by Date
Recorded by
0
PERMIT N0,
UTAF:_?1-92 36.00 io
PERMIT VALIDATION -
1616
DATE APPROVED 12`1-92
EXPIRATION DATE 12-13-92
-DATE ISS'U'D ^ 12-1-92
By 1-'I � Ma/""".
U 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: /� e—
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION �2�`� At�
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION -%��' Sketch (attach constructionlans if appropriate)
ppropriate)
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 per . and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result o is wo .
1 lure o p scant or ent
Name of Applicant (p
Telephone No.
Name of Conttractor and Job Foreman Business Address Telephone No.
�y�d J�� o LIVC
Contractor's License No. City Business License No.
5co =\&s ,%s 1"",6 73
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
Recorded by
1336
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
'TELEPHONE: (619) 564-2246