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1712•;NOTE:` = > .+•-+With proper" validation �so� 2.� + this form constitutes an CITY .OF LA WINTA 4N encroachment permit APPLICATION` FOR PERMIT R• ! '. 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 ?d . f };+�+* " • Subdivision Improvement Permit —Class III• -.'DATE-. 4/5/93 Minor Improvement Permit Class.IV t ';,,LOCATION OF CONSTRUCTION 52-400• EISENHOWER j �Z ' (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 "+ MENSION OF INSTALLATION'OR REMOVAL L, ''-'SIZE`OF EXCAVATION, IF NEEDED }APPROXIMATE TIME WHEN WORK WILL BEGIN 4/5/93 + ^ 4 APPROXIMATE TIME OF COMPLETION "-ESTIMATED CONSTRUCTION COST $ `,. (Including removal of all obstruction,materials, and debris, backfilling, com ,;t',paction and placing permanent resurfacing and/or replacing improvements) . In consideration. of the granting of this permit; the, applicant hereby agrees to: ' r b dei Indemnify,.clefend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all, f' "` ;ri penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or prope, rty happening or occurring as a proximate result of any work undertaken .under, the, permit granted pursuant to this application. ,' •tom:' - y•� 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 thea resu f this work. Signaturep•'rf\Applicant or Agent Name of Applicant,(please print) Business.Address Telephone No. SAI:V& PEPPER 368 BON AIR DR 321-1357 Name of Contractor and Job Foreman Business Address Telephone No. ::'61'6475 2734 ; .. ':Contractor's License No. City Bus inesslicense No.. ,%,:$AFECO TNS CP 2246906A exib. 1/27494. , 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�A€i i' �TA�` i. 34.i�'© Minor Improvement Permit —`Class IV: See attached schedule. ' Z. F , ,... • 20.00 :•• �. .. .� , �wlnspection=Fee $ PERMIT VALIDATION Permit..Fee a,• 10.00. 1712 PERMIT NO. ;...Penalty ♦`Cash Deposit Surety: Bond DATE APPROVED 4/5/93 if re4ui4d EXPIRATION DATE 4/6/'93 ~, .TOTAL: $ 30.00 ' DATE ISSUED X4/55193 Receipt No. Received by Date Administrative'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 —�� L� I �hw AX, L4,47 � (Street address or Description of Location) PURPOSE. OF CONSTRUCTION _/*) L/"< c''-✓� �/ Cl Sketch (attach construction plans if appropriate) DESCRIPTI N OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 4%-- :Z:9 7 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 whenrwork 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 necesiary,as the res t of this work. R Signaore of Applicant or Agent Name of Alicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman -Business Address a Telephone No. . Contractor's License No. City Business License No. 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 1 v L FJ - Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ PERMIT VALIDATION Permit Fee Penalty PERMIT NO. _ •i Cash Deposit -Surety Bond DATE APPROVED if required EXPIRATION DATE TOTAL: $ _ DATE 1 SSU E D Receipt No. By Received by Date 'Administrative Authority Recorded by �. TELEPHONE: (619)'564-2246'