1686r
NOTE: _
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
DATE: 3/9/93
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-100 AVE JUAREZ LA QUINTA. CA
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION DRIVEWAY APPROACH Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN /1111ft
APPROXIMATE TIME OF COMPLETION 3/11/93
ESTIMATED CONSTRUCTION COST $ $300
(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:
PER RIVERSIDE CO STD. # 207
(ATTACHED)
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 thehis work.
Signature of Applicant or Agent
BILL HOWARD PO BOX 1555 LA QUINTA CA (619) 564•-1.338
Name of Applicant (please print) Business Address Telephone No.
SAM AS ABOVE
Name of Contractor and Job Foreman Business Address Telephone No.
537333 2526
Contractor's License No. City Business License No.
OHIO CASUALITY BLO (93) 30057116
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
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.
$ 20.00
10.00
30.00
Received by Date
PERMIT NO.
i85180A18 ?673TRe—?1-93 30,0010
PERMIT VALIDATION
1686
DATE APPROVED 3/9/93
EXPIRATION DATE 3/19/93
DATE ISSUED 3/9/93
By
Recorded by 11 TELEPHONE: (619) 564-2246
Administrative Authority
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: .3 Subdivision Improvement Permit — Class III
/n� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION -- -- S `I "� �� t-'-yp_ -TJ P,( -
(Street address or Description of Locaion)
PURPOSE OF CONSTRUCTION W
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3 \0 3
APPROXIMATE TIME OF COMPLETION `)i 3
ESTIMATED CONSTRUCTION COST $ 3 00 —
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction plans if appropriate)
� A I/ &C83 -o t C - sT�
In consideration of the granting of this permit, the applicant hereby agrees to:
N 6. Zo 7 rr�� ro)
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 1241 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 r ult of t is work.
�.__ \
SI nature of Appli�f't or Agent
- I33�
e •f Applicant (please print) Business Address Telephone No.
S *YYk-A--
Name of Contractor and Job Foreman
1 3 73.3 3
Contractor's License No.
Applicant's Insurance Company
Business Address
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 $
,,-)- 6
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
-� Telephone No.
City Brnesinejss(ce�V Vnse No. ,1
—0 1 1 SS / I, (n
Number
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED — 3
EXPIRATION DATE 23^G� R3
DATE ISSUED J ' `' 3
By
Administrative Authority
TELEPHONE: (619) 564-2246
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