1816IVOTEj s
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: 7/23/99
LOCATION OF CONSTRUCTION 53-660 Rubio
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 7126193
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
PER RIVERSIDE COUNTY STD # 207
APPROXIMATE TIME OF COMPLETION 7/28/93
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 thb granting of this permit, the applicant hereby agrees to:
�a a
LjrJUL 2 6 1993 U
By
-------------
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
Was Development Co 77885 Montezuma La Quints, (619) 364-5354
Name of Applicant (please print) Business Address Telephone No.
Walter Stockman
Name of Contractor and Job Foreman Business Address Telephone No.
On Bile'
Contractor's License No.
On file
City Business License No.
On Pile On Bile
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required .
TOTAL:
Receipt No.
Received by
Recorded by
$ 20.00
10.00
$ 30.00
Date
1816
PERMIT VALIDATION
PERMIT NO. 1816
DATE APPROVED 7/26/93 �.
EXPIRATION DATE 7/30/93
DATE ISSUED 7/26/93
By
Administrative Authority
TELEPHONE: (619) 564-2246
J)
Y
li-
NOTE:
With proper validation
this form constitutes in
encroachment permit CITY OF LA OUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways. pavements, sidewalks, parking lots, sewm. water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Q M
DATE: l Subdivision Improvement Permit - Gass III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION _5-- O✓Lin
'Street address or Desertption of Location) I
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
Sketch (attach construction plans if appropriate)
?FjtZ ev✓ri,f�5i �2 Lo w�y
DIMENSION OF INSTALLATION OR REMOVAL 5� ?
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 7,*-,
ESTIMATED CONSTRUCTION COST S "-4pO- V
(Includingremoval 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 trot the, City. its authorized agents. offiesn. rearmntatives and employees, harmless from and
Penalties. liabilities or Ion resulting from claims w court action and arising out of any accident, lost or t 'nit any and all
haoPening or occ ring as a proximate result O1 any worst undtrtIke" under M• damage t0 persona or property
ourtuanj
this
Notify the Administrative Authority at least twenty-four 424) hours in advance of the tirr»nwhen work 'Hill be started tion.
Comply with all applicaya City Ordinances, the terms and conditions of the ptrmtt and all 800licablt rules end regulations of the City of
La Quints and to pay for any additional replacement nectssary as the result of this work.
Signature of Applicant or Agent -�
Name of Applicant (please print)S
f LTi 70G,�/Busineu Address Telephone No.
Name of Cont ctor and Job Foreman
/ &3 qlg Business Address Telephone No.
Contractor's `License No. - 2-5-3 Lf
L J RN CLIL 11-111/ City Business License No.
Applicant's Insurance Company W �� �g� gl
Policy Number
FEES: Subalvision 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 S Z a
Permit Fee /0
Penalty
Cash Deposit -Surety gond
if required
TOTAL: $ ,�G
Receipt No.
Received by Date
Recorded by
FA
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 7-
7-DATEXPIRATION DATE _ -7-
DATE
E ISSUED 7-- z-&
By
TELEPHONE: (619) 564.2246
Administrative Authority
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c - .�.
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