1704z
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 sewer�s�water mainsri�, f�
;.w
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
t
Subdivision Improvement Permit — Class III
DATE: UK= 3/29/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78-605 Sagebrush Ave La Quints
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Apyroach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
Per Riverside Country STD 0 217
(Attached)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/30/93
APPROXIMATE TIME OF COMPLETION
-.-,ESTIMATED CONSTRUCTION COST $
"•i',.(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�ermit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result f this, ork.
�., Signature of Appel icant or Agent
Bob Grimes 78-735 Sagebrusbh La Quinta MI 564-3098
Name of Applicant (please print) -- Business Address Telephone No.
Jesse Garcia 343-8919
Name of Contractor and Job Foreman Business Address Telephone No.
,6187061 _ 2105
Contractor's License No. City Business License No.
Pacific Fire (Bandy Rosten) 7211 EXP 5/26/9
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
,Receipt No.
$ 10.00
20.00
$ 30.00
Received by Date
Recorded by
x
10- 6A ?4'Ur'A'L__'1'-93 30.00io
1, # 0 4F
PERMIT VALIDATION
PERMIT NO. 1704
DATE APPROVED 3/29/93
EXPIRATION DATE4/2/93
DAT_E�_IISlSUED3/29/93
By , IM C
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
y.
3 Subdivision Improvement Permit — Class III
DATE: ' / Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION %Z `45 6_s
[reef aaaress or uescription of Location)
PURPOSE OF CONSTRUCTION � l.!/ * W_& 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 3 3 a
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 &"tits, 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 ofthe pe and all applicable rules and regulations of the City of
La O.uinta and to pay for any additional replacement necessary as the result of word.
Signature of jiplica t r Agent
8•- 7 3� S� rL3o 9 �
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
tappncanrs 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
13086
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246