17721:IOTE:
With proper validation r
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
Subdivision Improvement Permit— Class III
DATE: 6/23/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78-555 Sagebrush Ave L.Q.
(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
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 0 207
(Attached)
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 a
Comply with all applicable City Ordinances, the terms and conditions of
La Quinta and to pay for any additional replacement necessary as the re
of the time when work will be started.
perit and all applicable rules and regulations of the City of
ot; tFFis work.
Signature of,.<pdlicant or Agent
Cindy Howard 78-735 Sagebrush La Quinta "M53 564-3098
Name of Applicant (please print) Business Address Telephone No.
Jesse Garcia
Name of Contractor and Job Foreman
6189061
Contractor's License No.
343-8919
Business Address Telephone No.
2105
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 20.00
10.00
$ 30.00
Received by Date
1772
PERMIT VALIDATION
PERMIT NO. 1772
DATE APPROVED 6/23/93
EXPIRATION DATE 7/2/93
DATE IS UED 6 23/93
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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NOTE:
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
D&TE: h1K I `IJ
LOCATION OF CONSTRUCTION
q l Subdivision Improvement Permit —Class I I I
Minor Improvement Permit Class IV
is
(Street address or Description of Locati
PURPOSE OF CONSTRUCTION I It \y 1� ASA Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION %,ieS'D� C,,- —,v S'Tv
Al. ?_s77 r9.�Wo-e— /f2i:
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION/, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
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 applicaiiurn.
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 Quinte and to pay for any additional replacement necessary as the result of this work
Signature of Applica or Agent
1.1 Q c) Lu Al2-P 18`73S A ,&
Name of Applicant (please print) Business Address Telephone No.
31E C, —89 19
Name of Contractor and Job Foreman Business Address Telephone No.
Elf 9D 6/ Flo s
Contractor's License No. 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 $
Permit Feey
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
1236
PERMIT VALIDATION
PERMIT NO. Z
DATE APPROVED 2 93
EXPIRATION DATE �l3
DATE ISSUED Z_
By
Administrative Authority
TELEPHONE: (619) 564-2246