1767NOTE:
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
6/18/93
LOCATION OF CONSTRUCTION 53-960 Avenida Montezuma
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
i
PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Concrete Per Riverside County Htd. 207 (attached)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6/19/93
APPROXIMATE TIME OF COMPLETION 6/21/93
ESTIMATED CONSTRUCTION COST $ 500.00
(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 an�1 141 a plic-able rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of t isFivor. :
�net`ure of`Xpplicant or 4gent
DoDco Construction Services P.O. Box 1012 La Quinta, CA 92253 564-6478
Name of Applicant (please print) Business Address Telephone No.
Dan Featheringill Same
Name of Contractor and Job Foreman Business Address Telephone No.
397 830 B-1 1375
Contractor's License No. City Business License No.
Golden Eagle CCP 178 797
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
$ 30.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
Received by Date
PERMIT NO.
X67
PERMIT VALIDATION
1767
DATE APPROVED
6/18/93
EXPIRATION DATE 6/21/93
DATE ISSUED 6/,18/93
By
Administrative Authority
Recorded by 11 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 lou, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
y.
DATE:,C ` o Subdivision Improvement Permit — Class 111
LOCATION OF CONSTRUCTION
Minor Improvement Permit Class IV
.
53 _ q 60 A„2 �
Mum address or Oestrion of Ow �R L v .•..4
esti Location)
PURPOSE OF CONSTRUCTION 1/iLt ✓3 w-, 0`IDnfto�24
DESCRIPTION OF CONSTRUCTION - Co r- cx x -;iL
DIMENSION OF INSTALLATION OR REMOVAL /6 1 X S'
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN _6 -
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION I
ESTIMATED CONSTRUCTION COST S
(Including removal of 811 obstruction, materials, and debris, backfilli
pat:tion and platin ng' cam.
g 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, offteers,
Penalties. liabilities or on resulting from claim or court action and arising putt ofaa nd �I��• harmless from end egengt any a� all
happening or occurring as a proximew result of nv accident, lees o► damage to persona or pfpOjRy
any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four 1241 hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit 1
V Quante and to pay for any additional replacement laceent n applicable Holes negulatioro of tM City of
Y as the result o is
Si re of Applicant or Agent
O0O
Name of Applicant (paease ✓tC/•S Q 10 /Z 1.6 �G� c/7
print)
7K Fit l
Name of Contractor and Job Foreman
3 0
Contractor's License No.
Applicant's Insurance Company
Business Address
Telephone No.
Business Address Telephone No.
City Business License No.
rG
Policy Number
FEES: Subolvision Improvement Permit — Clau 111
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: S
Receipt No.
Received by Data
-----------
Recorded by —
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564.2248
~� op