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1729q. ':NOTE: 1 With •proper- -Val idation 2 :,ihis form constitutes an CITY encroachment permit . OF LA QUINTA . « APPLICATION FOR PERMIT ? t•:. , PUBLIC WORKS CONSTRUCT ION,AENCROACHMENT) OF THB�wS 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: 4-30-93 Minor Improvement Permit Class IV L:OCATION.OF CONSTRUCTION '54365 Eisenhower ` (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach con struction,plans if.appropriate) ' DESCRIPTION OF CONSTRUCTION Per Riverside,'County'.Std.' No. 207 (attached) iQ b79y 065,02 �4-30�g3; 14 �" '' . DIMENSION OF INSTALLATION OR REMOVAL �0 t~P15N i'QT�L`'i' `. 36,00 ` .SIZE OF EXCAVATION, IF NEEDED. APPROXIMATE TIME WHEN WORK WILL BEGIN 5-03-93 APPROXIMATE TIME OF COMPLETION 5-03-93 ESTIMATED CONSTRUCTION COST $ �� (Including removal of -'all obstruction, materials, and debris, backfilling, com- paction om paction and placing •per'manent 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 'y happeningor occurring as a proximate result of any work undertaken under the permit granted pursu nt 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 a plicable rules and regulations of the City of La'Quinta and to pay for' any additional replacement necessary as the result of this wo k. • Via. y ,'t.. �;' ' •1 t �gna/tre of Applicant or Agent PeRobert Snellenber er 55 695 bble Beach Uinta CA 92253 � Q � � � • ..777 7767 ° a Name of Applicant (please print)Businessr'Addres,i Telephone No. Jim 8 Sne]lenber er , .. Name of Contractor and Job Foreman Business Address j Telephone No. i- t;: 488234 '0120 Contractor's -License NO. City Business License No t • , Yarmere Ins. DEC16269400605.-° Applicant's Insurance Company Policy Number. „? ,FEES`..' •Subdivision Improvement Permit: =Class LII f' Public improvements: .3%.0f estimated construction costs ,. k Private Improvements: 3% of estimated construction costs r Minor Improvement Permit —Class IV: See attached schedule• u 1 Inspection Fee $ 20 PERMIT VALIDATION Permit Fee 10 17-29 PERMIT NO: Penalty4 4-30-93 Cash Deposit -Surety Bond DATE APPROVED } r• if requiredEXPIRATION DATE 5-4)744, TOTAL: $.. 30 xl,. ! +. . „•', `.4 3'0-93 DATE IJSSU J Receipt No. B Y Received byDate Administrative Authority Recorded by TELEPHONE: (619) 564-2246 k , •.lN»:�s;F3:c:id'a�,.�'S-f�:r»S.ti. '• .t'.rr:�c�rA.-1kktQro.w:;,r f - : t_ — NOTE: With proper validation this form constitutes an encroachment permit - CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public works improvements in, connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS y . DATE:- G/ � Subdivision Improvement Permit — Class III Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION - Sy� 36S /�•S�//�/S�©Gy�/i�. (Street address or Description of Location) L. PURPOSE OF CONSTRUCTION -- 2�7i'09,1f_ W 4'61Sketch (attach constructionlans if appropriate ppropriate) DESCRIPTION OF CONSTRUCTION — !:704/ DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WQRLWILL BEGIN APPROXIMATE TIME OF COMPLETION / iQ ESTIMATED CONSTRUCTION COST$ (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 lossresulting 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 (241 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 Quints and to pay for any additional replacement necessary as the result of this work. /'1 _ _ �? Name of Applicant (please print) 317rof Applicant or gent Business Address Telephone No: Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business License No. i�G ���694io�6o5 Applicants Insurance Company Policy Number FEES: Subolvision 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