1779`NO$E .•
With.,p_rgper 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
Subdivision Improvement Permit — Class III
DATE: 6/28/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78-590 Bottlebrush La Quinta
I
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Asphalt Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Install asphalt approach
DIMENSION OF INSTALLATION OR REMOVAL 16'X15'
SIZE OF EXCAVATION, IF NEEDED N/A -41
APPROXIMATE TIME WHEN WORK WILL BEGIN 6/29/93
APPROXIMATE TIME OF COMPLETION 7/2/93
ESTIMATED CONSTRUCTION COST $ 400.00
(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 t ork.
Signature of Applicant or Agent
Paul Gibson 76-590 Bottlebrush 360-2263
Name of Applicant (please print) Business Address Telephone No.
Nicholas Development Corp P.O. Box 13510 Palm Desert 340-3080
Name of Contractor and Job Foreman Business Address Telephone No.
575731 3802
Contractor's License No. City Business License No.
Golden Eagle Ins CLV05310
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 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
Received by
10.00
$ 30.00
Date
I9
PERMIT VALIDATION
Recorded by TELEPHONE: (619) 564-2246
1779
PERMIT NO.
DATE APPROVED
6/28/93
EXPIRATION DATE
7/2/93
6/28/93
DATE ISSUED
By
4,9A^A4^-._
Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
i . -
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:--�
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 4291#27 -17 -Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION 2A -Cr'
DIMENSION OF INSTALLATION OR REMOVAL &'Y /`:7—
SIZE
'SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ti 'a' 57-73
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ - �Uo
(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 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 Quints and to pay for any additional replacement necessary as the result of this work.
Name of Applicant (please print)
Name of Contractor and Job Foreman —T
5-75-721
Contractor's License No.
Applicant's Insurance
Applicant or Agent
Business Address
Business Address
3�c�- 2Lko3
'1 c, Telephone No.
V . /�. 5 ��2 �`/o 3.0 1?,)
Telephone No.
38oa
City Business License No.
t- Y 05 31
Policy Number
FEES: auboivision 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 $ Zg
Permit Fee % d
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ - d
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED t4J (i 3
EXPIRATION DATE 71?,15
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authority
IN
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