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1627ROTE:, With proper validation this form constitutes an encroachment permit ri CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) f 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 I II DATE: beCt�itber 14, 1992 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 54-270 Avenida Martinez (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveway Approach DESCRIPTION OF CONSTRUCTIONf=an 51 11CA Q-.-' DIMENSION OF INSTALLATION OR REMOVAL .SIZE OF EXCAVATION', IF NEEDED I� APPROXIMATE TIME WHEN WORK WILL BEGIN 12/14/92 Sketch (attach construction plans if appropriate) 4 Per Riverside County Std. 207 (attached) APPROXIMATE TIME OF COMPLETION 1 1 LOU I (PI `?ck ESTIMATED CONSTRUCTION COST $ 500.00 (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 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. t Sig t& f/4ppl or gent Santa Rosa Coustruetiarn, Inc. P#O. BOX 1774 La Quanta, CA 92253 564-1837 Name of Applicant (please print) Business Address Telephone No. ( Salla Name of Contractor and Job Foreman Business Address Telephone No. 365814 2001, Contractor's License No. City Business License No. Carml ineuranta 40673375 Applicant's Insurance'Company Policy Number FEES: Subdivision Improvement Permit — Class 111 o i Public improvements: 3% of estimated construction costs �81BR7TM�a-�2 34. ©41Q 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 20.00 10.00 $ 30.00 Date 1627 PERMIT VALIDATION PERMIT NO. 1627 DATE APPROVED 12/14/92 EXPIRATION DATE 12/16/92 DATE ISSUED 12/14/92 By SJS6�2� Administrative Authority Recorded by 11 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: l2111011%Z Subdivision Improvement Permit — Class III Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Z9ZI 1��'Lw>�y �QQ2pgC„/ 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 FFG 4 APPROXIMATE TIME OF COMPLETION /01E� /6, /9-7;7— ESTIMATED q'9ZESTIMATED CONSTRUCTION COST $ 5_61?911 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 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. Signat e p 'cant,,dr Agent ��ir� T% �JA Coiy'v 7' /OIi G � •o. � /72�5t /.4 Qf e i.t.T7� .�� / �� Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. s� 14 2®oi Contractor's License No. City Business License No. el.91 z i/tfS tGYO�33�S Applicants 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 13�F� PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE: (619) 564-2246