1752NO
With 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
DATE: 6/q/93
LOCATION OF CONSTRUCTION 52-255 Ave Carranza
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
(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 6/5/93
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:
Per Riverside County STD # 207
(Attached)
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
I
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 the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the dermit and all applicable rules and regulations of the City of
La Quinta and to pay for any- additional replacement necessary as the result hof this work.
Signatureof Appplfcant or -Agent:
John Vela Jr 31380 Sky Blue Water Cathedral City 345-0522
Name of Applicant (please print) Business Address Telephone No.
SAME
Name of Contractor and Job Foreman Business Address Telephone No.
337559
Contractor's License No.
2862
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
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
10.00
$ 30.00
Receipt No.
Received by Date
PERMIT NO.
a i 8LA1�{� i 3 Tt��' 4�y3 30.00
1 752
PERMIT VALIDATION
1752
DATE APPROVED 6///93
EXPIRATION DATE 6/11/93
DATE-ISSUED,,���� 6/1//93
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
59
O �
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
11
DATE: / Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Desorption of Location)
PURPOSE OF CONSTRUCTION ,Ai0,4-e tl
DESCRIPTION OF CONSTRUCTION L 6 fl C A'
DIMENSION OF INSTALLATION OR REMOVAL Co
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 4/
ArrKUXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS
(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:
Sketch (attach construction plans if appropriate)
/ i1, /
Rx"
Indermnity, defend and saw 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 pmlmlR"
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 124) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the pe it and all applicable rules and regulations of the Clty of
Le Quints and to pay for any additional replacement necessary as the is work.
Ito th
l9Mor Agent
Name of Applicant (please print)
Business Adbliess Telephone No.
C -3g 01 Cv�
Name of Contractor and Job Foreman
G Business Address Telephone No.
Contractor's License No.
OLE" City Business License No.
Applicant's Insurance Company
Policy Number
FEES: Subdivision Improvement Permit — Class111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ :;).o- 0 0
Permit Fee 10. 00
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
1%1.1086
Administrative Authority
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