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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
Subdivision Improvement Permit— Class III
DATE: 7/6/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-805 Obregon
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION WRB Cut Driveway 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 7112/93
APPROXIMATE TIME OF COMPLETION 7/12/93
ESTIMATED CONSTRUCTION COST $ 300.00
(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:
Per Riverside Countyy= # 207
(Attahhed)
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.
Signature of Applicant or Agent
Harris Nieusma. 4883 Voltaire Ave San Diego 92107 (619) 221-0344
Name of Applicant (please print) Business Address Telephone No.
Curb Saving.
Inc 321-9700
Name of Contracfbr and Job Foreman Business Address Telephone No.
589084 2095
Contractor's License No.
City Business License No.
Safeco 80154620
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.
Received by _
Recorded by
$ 20.00
10.00
$ 30.00
Date
J111
1796
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
1796
7/6/93
EXPIRATION DATE 7/16/93
DATE IS UED 7/6/93
Administrative Authority
TELEPHONE: (619) 564-2246
I&
r. .
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: b 1� Subdivision Improvement Permit - Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION _ r)S�LEC_) jJ
,� �,
(Street address or Description of Location)
�PURPOSE OF CONSTRUCTION -L0402)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN --
rt7
'APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $-- �1
(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)
lndemnifv, defend and $aw the City, its authorized &gens, 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 124) 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 n 1 - m ry as the result of this work.
Name of Applicant (please print)I.
_
2� S AI YC
Name of Contractor and Job Foreman
Contractor's License No.
1J rr /'-� c, C>
Signature of Applicant or Agent C� q2
8 �oU2il C v b� ��O� zzl(o3
Business Address Telephone No.l
3Z/- 9704
Business Address Telephone No.
?5 --
City Business License No.
Applicant's Insurance Company Policy Number
FEES:01ubolvision 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 / O
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 3
Receipt No.
Received by Date
Recorded by
12086
PERMIT VALIDATION
PERMIT NO. -7 �F(,-
DATE APPROVED %— &- 73
EXPIRATION DATE 7-
DATE ISSUED 7 , & - �3
By
TELEPHONE: (619) 564-2246
Administrative Authority
I
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