1640NOTE:
\hath 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
Subdivision Improvement Permit — Class III
DATE: 1$/29/92 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-400 Carranza
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Aayroach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
E
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Per Riverside County Std. 207 (Attached)
APPROXIMATE TIME OF COMPLETION 1/4/93
ESTIMATED CONSTRUCTION COST $ 2.000
(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 this work.
Signature of Applicant or Agent
Phillip & Maryland Davis 54-400 Carranza, La Quinta, CA 92253/ 564-1518
Name of Applicant (please print) Business Address Telephone No.
Owner / Builder
Name of Contractor and Job Foreman Business Address �` Telephone No.
N/A N/A
Contractor's License No. City'Business License No.
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 $ 20.00 II
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond,
if required
. TOTAL: $ 30.00
Receipt No.
Received by Date
PERMIT NO,
PERMIT VALIDATION
1640
DATE APPROVED 12/29/92
EXPIRATION DATE 1/4/93
DATE ISSUED 12/29/92
By '
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: I I -q q
Subdivision Improvement Permit — Class III
' II Minor Improvement Permit Class IV
LOCATf011 :CANSTQU. TION s`'t ob CA R A 0 -24
(Street address or Description of Location)
PURP_OSEjOF•`CONSTRUCTION DR t VE WA � Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTfiUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
IrAPP.R:OX'.I:MA_T.E9TIMEiOFZCOMPIETAON -, i
ESTI\ MATED CONSTRUCTION -COST;$? _000
(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 124) 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.
A 11L I,P AM0 fi%
Nameof°Appl:icant _(pleaseLprjiintD
Signature of Applicant or Agent
Business Address
-is- 19
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
r,Npncani s Insurance trompany 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
0C.
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246