1637NOTE:
With proper validation
'�N,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
DATE: 12-22-92
LOCATION OF CONSTRUCTION53-745 Mandbati
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Safety $t"BOUS Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION PEOV"e spdCe between Bee attacW eketch
gate amd steps
This, permit is ody for the
DIMENSION OF INSTALLATION OR REMOVAL tAstauatiow,of the V#,Ors F
2'w3' in, the, City Right of Way.
i
SIZE OF EXCAVATION, IF NEEDED
i
APPROXIMATE TIME WHEN WORK WILL BEGIN 1x-23'924 130.00
1 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) i
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 prope, rty . �)
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
Michael 3 De.Androa $3-945 Kendon LA gnihta CA 564-0339
Name of Applicant (please print) Business Address Telephone No. t
PBA Const. 45250 8nrr. St. !12 344io, CA 345»9115'
Name of Contractor and Job Foreman Business Address Telephone No.
54780 3469 i
Contractor's License No. City Business License No.
Sfingi Ha=on PW C36312343
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
20
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10
$ 30
Received by Date
Recorded by
1637
PERMIT VALIDATION
PERMIT NO. 1637
DATE APPROVED 12-22--92
EXPIRATION DATE 1-15-93
DATE'SS ED .� 12"22-92
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: (�" ;L2- 9 Subdivision Improvement Permit- Class III
-_ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION -- r3 - 7 j Sv%1107-AQ vlo q
(Street address or Description of Location)
PURP SE OF CONSTRUCTI N - 5• t -m e •v t _S
b
DESCRIPTION OF CONSTRUCTION rK
n t %_ LPG
-DIMENSION OQNSTALLATION.OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN - cZ-�?._--5.2
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materia;s, 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)
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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-- n ` Signature of AppTi4ant or Agent
le -42t'.01 .
Name of Applicant (please print)
L— Coo
53-74(S Aug
Business Address
Name of Contractor andel Job Foreman
�'7 1 �
Contractor's License No.
/JO tj
Business Address
dozA- 36y-03
Telephone No.
. #(Z..--NDta/ Crl
Telephone No.
/ Y6 9
City Business License No.
wC C -31o3 /ZS y3
Applicant's InsuranceCompany 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 $ zo
Permit Fee tv - II
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
*5 YS -11/5-
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11/fZ Zo 1
�?GF.
PERMIT NO, i t 37
DATE APPROVED �1Z - ZZ � Z
EXPIRATION DATE 1- (5 -CCZ
DATE ISSUED I Z , 2 Z —q
By
Administrative Authority
TELEPHONE: (619) 564-2246
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