1675NOTE:
With proper validation' '
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
Subdivision Improvement Permit — Class I I I
DATE: 2--23.93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION, 52-'654 Eisenhower
(Street address or Description of Location) '
PURPOSE OF CONSTRUCTION dr#.vexng aj) )roacl Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION per Riversido Co. Std. 207
(attached)
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) '
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 alp
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.
~ Sjgr afa ure of Applicant or Agent `
VarAas & Sona Cotterel' • 975, Calf's Patel 'PiAla Sorifags itA •* 325-9478
Name of Applicant (please print). •Business Address Telephone No.
Name of Contractor and Job Foreman. Business Address '; Telephone No.
574$59
Contractor's License No: - City.Bdsiness_ License No.
opt f Ile ,
Applicant's Insurance Company Policy Number
10
FEES: Subdivision Improvement Permit — Class III' 0'0
' t
Public improvements: 3% of estimated construction costs ' -
Private improvements: 3% of estimated construction -costs
.Minor Improvement Permit — Class IV: See attached schedule ', I
r.
Inspection Fee $ 2Q ' PERMIrTw VALIDATION
Permit Fee PERMIT NO. 1675
Penalty 2-23-93
Cash Deposit -Surety Bond- DATE APPROVED
if required*-,- EXPIRATION DATE 2-28-93
TOTA L:. $ 30 2-,23-93.. - DATE IS•UED�'
Receipt No.
By—
Received
Received by DateAjr —dministrative Authority
Recorded by 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
DATE: - Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Z L _ Q
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if a
-r s P appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL tco
SIZE OF EXCAVATION, IF NEEDED -- iC�
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)
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.
Sig re of Applicant o4Agen
Name offApplicant (please print) Business Address n Telephone No.
1p
Name of Contractor and Job Foreman
7-I19S'S
Contractor's License No.
16
Business Address
Telephone No.
City Business License No.
Applicant's Insurance Company B
Policy Nur-ter
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
Administrative Authority .
TELEPHONE: (619) 564-2246