17984 `•-
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
DATE: 7:8/93
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-120 Ave Vallejo "'
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Cut curb saw 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 # 2078
P A I iD juL 0 8
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 Agerii -'
Robert W. Sharman 529120 Ave Vallejo La Quinta
Name of Applicant (please print) Business Address Telephone No.
Curb Sawing Inc 321-9700
Name of Contractor 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:
20.00
10.00
$ 30.00
Receipt No.
Received by Date
17,98
PERMIT VALIDATION
PERMIT NO. 1798
DATE APPROVED 7/8/93
EXPIRATION DATE
7/15/93
DATE , IS ED �7/8/93
By ..��
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
t
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: 4 /�L Subdivision Improvement Permit — Class III
Minor Improvement Permit Clan IV
X LOCATION OF CONSTRUCTION �� lyl7D v I/,qz i .c.,•_
(Street address or Description of Location)
E OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSJ�4LLATION OR REMOVAL.'40
,Dice/vett Z,iAr . 41LFWL t .l6,ar/l T,9+ .?o
SIZE OF EXCAVATION, IF NEEDED
APDXIMATE TIME WHEN WORK WILL BEGIN
_7„ i, /rats e
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:
Sketch (attach construction plans if appropriate)
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 a 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 necmury as the result of t_tj*work.
Name of Applicants lease print)
x ds
Name of Contractor and Job Foreman
W
Contractor's License No.
Signature of Applicant or Agent
Business Address
Business Address
Telephone No.
Telephone No.
N
City Business License No.
IV
Applicant's Insurance Company Policy Number
FEES: Subolvision 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 Date
Recorded by
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
1 vU�•
Administrative Authority
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