1819NOTE:
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: 7/28/93
LOCATION OF CONSTRUCTION 54-140 Martinez
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Cut curb & Approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 128= 8/2/93
APPROXIMATE TIME OF COMPLETION 8/2/93
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) 4 `�
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
4
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.
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
PER RIVERSIDE COUNTY STD # 207
(ATTACHED)
it
pQ%°D
4JU2 8 1993 D
By_SL
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 Appli nt o Agent
Kenydn and Bradley Jones 78-738 Aknold Palmer La Quinta 771-0511
Name of Applicant (please print) Business Address Telephone No.
Owner
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
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
$ 20.00
10.00
$ 30.00
Date
V
PERMIT NO
18,19
PERMIT VALIDATION
1819
DATE APPROVED
7/28/93
EXPIRATION DATE 8/6/93
DATE ISS ED j 7/28/93
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
M i
i
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 lou, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE:- 7/ 2-V 9 3 Subdivision Improvement Permit - Class III
LOCATION OF CONSTRUCTION _Sq- 1,(o Minor Improvement Permit Class IV �e MG r�; we z;
(Street address or Oesenption of Location)
PURPOSE OF CONSTRUCTION C,6 C",4- 4 AjwrtoA_,_�
ro
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 11J7n F ay
SIZE OF EXCAVATION. IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN -Kos. _ A. k . I-, "13
APPROXIMATE TIME OF COMPLETION Mo-- 9011-M3,_
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, offkan, representatives and employees, harmless from and against any and all
penalties, liabilities or 109 resulting from claims or Court action and arising Out of any accident. lots or
damage
happening or occurring as a proxinwe result of any work undertaken under the permit granted pursuant to this ap pectous or property
pPlintgn.
Notify the Administrative Authority at least twenty-four 124) hour in advance of the time when work will be started.
Comply with all applfceble 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 ad litlonal replacement necessary as the result of this work.
r...,.oi o r-c..Ch k e
Name of Applicant (please print)
Signature of Apfdicvt or Agent
A, --Old PC_ 1 *.e 11 l-1- 01 , ,. b c q `I `l 1-aIC' 11
Business Address
Telephone No.
- R, , Id t.
Name of Contractor and Job Foreman Business Address
Telephone No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subalvlslon 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 $ 2a
Permit Fee 1 t7
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ -5a
PERMIT VALIDATION
PERMIT NO. - /9 / n%
DATE APPROVED r -
EXPIRATION DATE 9-6-93
DATE ISSUED - -7- Z f -''3
Received by Date By
Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
0,
ilk