1750(VOTE:
lith 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
f
Subdivision Improvement Permit —Class I I I
DATE: May 25, 1993 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-160 Avenida Valleix
(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
Per Riverside County Std. 207 (Attached)
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 250.00
(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.
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 result of this work.',,.r
Signature of Applicant or.A ent _ _
General Contract Mana
Name of Applicant (please print)
Name of Contractor and Job Foreman
524-325
P.O.
x"... La Quints, CA 92253 564-14
Business Address Telephone No.
Business Address
OhIl-Fi:
Telephone No.
Contractor's License No. City Business License No.
On File On File N.
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 $ 20.00""
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
PERMIT NO.
9'�A� TA
N51 - S-93 30.0050
1.750
PERMIT VALIDATION
1. 1750
DATE APPROVED
EXPIRATION DATE
5/25/93
5/28/93
DATE ISSUED 5/25/93
By I►
Administrative Authority
TELEPHONE: (619) 564-2246
40
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
v -
DATE: S �� —_7j Subdivision Improvement Permit —Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S , �� G /kt�� 1/��
(Street address or Description of Location) -
PURPOSE OF CONSTRUCTION �/ U� k nitreJ
Sketch (attach construction plans if appmon")
DESCRIPTION OF CONSTRIsr_Tlnlu
DIMENSION OF INSTALLATION OR R MOVAL
SIZE OF EXCAVATION, IF NEEDED 'i I 5C / r
APPROXIMATE TIME WHEN WORK WILL BEGIN —2
/. . _ -
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(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 saw the City, its authorized agnate, officers, representatives and employees, harmless from and against any and all
Penalties, liabilities or on resulting from claims or court action and arising out of anY accident, loss or
happening or occurring as a proximate result of any work undertaken under the Permit granted Pursuant damageant to this ap parsons or property
pplication.
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 Ouinta and to pay for any additional replacement necessary as the result of this work.
of Applicant (please print)
_`&t t —C L�S�-hcG� /zit
Name of Contractor and Job Foreman
Contractor's License No.
cl-
Applicant's Insurance Company
Signature of
Business Address
Business Address
Telephone No.
Telephone No.
City Business License No.
Policy Number
FEES: Subolvision Improvement Permit — Class II 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.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564.2246