1701NOTE:
U�ith 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 II I
DATE: March 22, 1993 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
53-800 Eisenhower
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
Per Riverside County Std. 207 Attached
DIMENSION OF INSTALLATION OR REMOVAL 6 x 20'
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/22/93
APPROXIMATE TIME OF COMPLETION 1 week
ESTIMATED CONSTRUCTION COST $ 400.00
(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.
/� r
Comply with all applicable City Ordinances, the terms and condition `s pf the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the esult thiswork.
�, 5s
Signature f Applicant or Agent
David Ross Miller P.O. Box 722 La Quinta, CA 92253 56475823
Name of Applicant (please print) Business Address Telephone`No.
Pacific Trades Hain
Name of Contractor and Job Foreman Business Address Telephone No.
8425381 1955
Contractor's License No. City Business License No.
Fa=ers Insurance 91 082 81 94
Applicant's Insurance Company 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
$ 20.00
10.00
$ 30.00
Date
105'8&ig iTTk-J2-93 30.00i0
1701
PERMIT VALIDATION
PERMIT NO. 1701
DATE APPROVED 3/22/93
EXPIRATION DATE 3/29/93
DATE ISSUED 3/22/93
By— AQ��4_ A4&�
t -dministrative 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
�� Subdivision Improvement Permit — Class III
DATE:—,3Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION �-t 15.cK&`yt�
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION �`%�—"� Z-7 Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 2-0
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETIONK-
ESTIMATED CONSTRUCTION COST $ ua7
(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:
Indemnity, -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\ef
the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions oit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the i o
%SSS k 11 L+1.
Name of Applicant (please print)
Q q—t. k �- ; �— —t.(L 0\-D f,S
Signature of Al
VC). 'X 1Z
Business Address
cant or Agent
`q syy -S 1i 3
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicants Insurance Company 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
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authority