17621
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
DATE: 6/11/93
Subdivision Improvement Permit —Class I I I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Driveway 53-740 Martinez 4
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Concrete approach Per Riverside Count 07
(Attached f 8SiS { AA�_f -93 MAID 3
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6/14/93
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:
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.
00,
Signature of Applicant or Agent
Sun Crown Corp 564-5231
Name of Applicant (please print) Business Address Telephone No.
Larry Donoho Const Co
Name of Contractor and Job Foreman Business Address Telephone No.
627265 2154
Contractor's License No. City Business License No.
State Fund 1270495
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
IV,
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
1762
6/11/93
EXPIRATION DATE 6/18/93
DATE ISSUED 6//11/93
By ...i/)%1 f � Q
Administrative Authority
TELEPHONE: (619) 564-2246
AP
0 . 1:
NOTE:
With proper validation
this form constitutes an
encroachment oermrt
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: ll
LOCATION OF CON TRUCTION_—'
(Street address or Oescription of Location)
PURPOSE OF CONSTRUCTION G .-
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN ViRK WILj,,qEC�IN
Subdivision Improvement Permit — Class III
--.,—Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
01 IRK -
4,v Za 7 r¢7j,t ty-,E ID
APPROXIMATE TIME OF COM TION tl
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:
Indemnity, lie efend and saw the City, its authorised
Penalties, liaagents, officers. representatives and employees, harmless from and against any and all
bilities 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
LAI Ouinta and to pay for any additional replacement necessary as the result of this work.
?z
I Signature of Applicant or Agent
Name Applicant (please print)
Name q# Contractor and Job Foreman
Contractor's License No.
Business Address
Business Address
�C
Telephone No. g /
Telephone No.
City Business License No.
Applicant's Insurance Company
Policy Number
FEES: Subo►vision 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 i' a
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATE
DATE ISSUED -- w —93'
Received by . Date BY
Recorded by
TELEPHONE: (619) 564-2246 Administrative Authority
Tt