1621' fCNOTE:
h proper validation
this form constitutes an
encroachment permit
q W.
- 'CITY OF LA QUINTA
y 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 iwconnection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
I ..
DATE: Dicember 3, 1992 - ^ .
LOCATION OF CONSTRUCTION 77-545 C411e Madrid
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach • Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Concrete. Per RIver>side County Std.I 207 (Attached)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 12/7/92
APPROXIMATE TIME OF COMPLETION 12/11/$2
ESTIMATED CONSTRUCTION COST $ 150.00
(Including removal of all obstruction, materials, and debris; backfilling, com-
paction and, placing permanent resurfacing and/or replacing improvements)%
In consid'eration of the granting of this permit, the applicant hereby agrees to:
f
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 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
Suncrown Corporatiou 'La Q014t8, CA, 56405231
Name of Applicant (please print) Business Address Telephone No.
Larry Donoho Construction $2740 A1v6rado La Quitiita, CA 564-5231
Name of Contractor and Job Foreman Business Address Telephone No.
627265 2154
Contractor's License No. ^ City Business License No.
State Fund 1270495
Applicant's Insurance Company Policy Number
FEES:Subdivision Improvement Permit — Class 111
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
10.00
Permit Fee'
Penalty
Cash Deposit -Surety Bond
if required, ( �'
TOTAL: `14. $ 30000 `
Receipt No..
Received by Date
Recorded by
62
PERMIT VALIDATION
PERMIT NO. 1621
• DATE APPROVED 12/5/92
EXPIRATION DATE • 12/11/92
DATE ISSUED 12/3/92
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 constructionof 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
n / Subdivision Improvement Permit -7 Class III
DATE:_- 3 %v Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 7T
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIeTION OF CONSTRUCTI
DIMENSION OF INSTALLATION OR REMOVAL
-Su 22 '
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
L217 / q ?-- -
Sketch (attach construction plans if appropriate)
4
,
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 applicable rules and regulations of .the City of
La Quinta and to pay for any additional replacement necessary as the result of this work. ; r
Name of pplicant (please print) v
Glu' 7 Z y a *ado • 6 A)r ?
Name of CO'ntractor and Job Foreman
Contractor's License No.
• SU/�.2f�t1�✓ LOQ U,e/r�� o'/�
Signature of Applicant or Agent
Business Address Telephone. No.
3;s-6 C/
Business Address �rn. Telephone No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
t.
Public improvements: 3% of estimated construction costs J
Private improvements: 3% of estimated construction costs 1 %,3U FJ
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
j Permit Fee II
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by • Date
Recorded by
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authority