1628'NOTE
With proper validation
this form constitutes an ` CITY OF LA QUINTA
'encroachment permit -
APPLICATION FOR PERMIT ?
i
a
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT).
For the construction of°'public or private curbs, driveways, pavements, sidewalks lots, sewers, water mains
and other like public works improvements in connection with MI NOW IMPROVEMENTS and APPROVED SUBDIVISIONS
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Subdivision Improvement Permit— Class III
DATE: December .15. 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 2"0801 aerrera
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Curb having Sketch (attach construction plans if appropriate)
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DESCRIPTION OF CONSTRUCTION Uriva Way 422roaetk
i PelfAiveroide County
-�8td. 207
DIMENSION OF INSTALLATION OR REMOVAL `' `A4
SIZE OF•EiXCAVATION, IF NEEDED '
APPROXIMATE TIME WHEN WORK WILL BEGIN"'16^�9Z
APPROXIMATE TIME OF COMPLETION 1l'"1"•g�
ESTIMATED CONSTRUCTION COST $ ;600 r '
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
AL
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify,•def end and save the City, its authorized •agents, officers, representatives and employees, harmless'from and against any and all
Y ' 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. ..
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SigpKture of 4pplicant or`Agent
` „Co>ronel Congrruotiou P.0, Bax 123$ La ClAnta, CA 92253 564r-4. 604 '
Name of Applicant (please print) Business Address Telephone No.
Cush Saving 31-2$5 Avo* Marayiila Cathedral. City 92234
Name of Contractor and Job Foreman Business Address Telephone No.
}
No -m- alt FUE #5690$4 ON FILE #2093 �
Contractor's License No. City Business License No.
SAFECO ' ON FILE 014 FILE
Applicant's Insurance Company , j 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'`g
Inspection Fee $ 20
Permit Fee 10
Penalty
Cash Deposit -Surety Bond
if required `
i
' TOTAL: $ 30
Receipt No.
r
Received by Date
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Recorded by
PERMIT NO.
PERMIT` VALIDATION
1628
DATE APPROVED
12-15-92 `
EXPIRATION DATE 12-18-92
DAT ISSUED 12-15-92
By
I — 4 - 74� Administrative Authority
TELEPHONE: (619) 564-2246
,
t
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:_ .� �'7 Z Subdivision Improvement Permit- Class III
C`��0 I-1ii P�e-r� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION f53_MU
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION -
14
DESCRIPTION OF CONSTRUCTI
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN a 1 4 9
APPROXIMATE TIME OF COMPLETION - aL� 8 9 a
ESTIMATED CONSTRUCTION COST $ _00-
(Including removal 04 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:
Sketch (attach construction plans if appropriate)
Q4-0- 0- R I U t. iN.-S I (t--) (:�
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or lou 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.
�\
Name of Applicant (please print)
Name of Contractor and Joh Foreman
Signature of Applicant or Agent
Business Address
Business Address
Telephone No. ,
T, L-, �Qa:�P
Telepho No.
j
_ �;? o 9.
Contractor's License No. City Business License No.
Applicants Insurance Company poli..., Nurnbe.
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 $ OR 0
Permit Fee O II
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
$ 3(o
Receipt No.
Received by Date
Recorded by
10�F�
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED / a - I S " 9 �
By
Administrative Authority
TELEPHONE: (619) 564-2246