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1652
.With proper validation,-, .8.4 _-r., - - this form constitutes an CITY OF LA QUINTA encroachment permit 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 1-21-93 LOCATION OF CONSTRUCTION 77-500 Calle Chillon (Street address or Description of Location) i PURPOSE OF CONSTRUCTION driveway approach DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 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) Subdivision Improvement Permit —Class I I I Minor Improvement Permit Class IV Sketch (attach construction plans if appropriate) per Riverside Co. Std. No. 207 (attached) 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 propeety 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 Ouinta and to pay'for any additional replacement necessary as the result of this work. ~ 'ignatu/rre/of Applican r Agent Ray Duff 13130 Santa Ysabel Dese`r17t Hot Springs Ca 329-0904 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address - Telephone No. owner builder 571-747 2337 Contractor's•,License No. City Business License No. Construction services Bond NO. 671472 Applicant's Insurance Company Policy Number FEES: ^ Subdivision Improvement Permit — Class III ` :g��$r�4_� "�3' 30-.00t0 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 PERMIT' VALIDATION Permit Fee Penalty Cash Deposit -Surety Bond if required , TOTAL:, Receipt No. 10 $ 30 Received by Date Recorded by PERMIT NO. 1652 DATE APPROVED 1-21-93 4 EXPIRATION DATE 1-29-93 DATE IS UE 1-21-93 By 1115 1 91 1,9,mwV�, 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 Subdivision Improvement Permit —Class III Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGINx V — 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. Name'of Applicant (please print) Signature of O Jnr Business Address /6/9 ) 3.2 9 -1, 9©Lj Telephone No. OIL . U UL1-- 17AS;51U2 7 13 i.30 AJ r A s�a �� 4- %/l93,99 6 90/1 Name of Contractor and Job Foreman Business Address Telephone No. 3 7 Contractor's License No. City Business License No. C., S7/- 714,- 7T ,/ �kl D NO Applicant's Insurance Company 7/� 7� C;V4j ��- L.1IL.t-W rc!icy 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 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By TELEPHONE: (619) 564-2246 13086 Administrative Authority