1820NOTE: `R
With proper variation �•
this form constitutes an
encroachment permit
0 -
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
7/27/93
LOCATION OF CONSTRUCTION 78-500 Ave Tujun$a
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach 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 7/28/93
PER RIVERSIDE COUNTY STD # 207
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a
,:JUL
, F�
APPROXIMATE TIME OF COMPLETION 7/29/93
ESTIMATED CONSTRUCTION COST $ By -
(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 advanc of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the etmit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result • this work.
Signatur4 of Applicant or Agent
A & M CONSTRUCTION P.O. Box 366 La Quinta 564-4832
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
487584 12300
Contractor's License No. City Business License No.
West American Ins BLW (93) 50364647
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
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
180
PERMIT VALIDATION
PERMIT NO. 1820
DATE APPROVED 7/29/93
EXPIRATION DATE 8/10/93
DATE ISSUED , 7/30/93
By rw_ - v i i
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
c
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: July 27, 1993 Subdivision Improvement Permit — Clea III
Minor Improvement Permit Coss IV
LOCATION OF CONSTRUCTION 78 500 Avenida T jufu gar La Quintar CA
IStr/et address or Description of Loationl
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
t4a hP rn.�- o c e n
SIZE OF EXCAVATION. IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN July 8-1993
APPROXIMATE TIME OF COMPLETION— .T„l��c� 1C)93
ESTIMATED CONSTRUCTION COSTS 1165.00
(Including removal of all obstruction, materials, and debris, backfilling, com
paetion and placing permanent resurfacing and/or replacing improvements)
stat tans nstruction plans if appropriate)
l7
P�
In consideration of the granting of this permit, the applicant hereby agrees to:
I Wo nety. defend and saw the Ci '
ty, its authorized agents, officers. reptfsentatives and employ harmless from and against any and all
happening
liabilities in loss resulting from claim or court anion and wising out of any accident, loss or
happenmq or occurring a a proaotsate result of any wort under ken under the �^'� persona a property
Permit grantee pursuant to this application.
Notify the Administrative Authority at Ices[ twenty-four 1241 hours in
Of the time when wort will be started,
Comply with all applicapla City Ordinances, the terms and conditions of the rmrt and all applicable rules and regulations of the City of
La Quints and to pay for any additkwW raplaeament necessary as the result t this wort.
w
Signatu a of Applicant or Agent
Name of Applicant (please print)`ZZ564-4832
Business Address Telephone No.
A&M OCNSTRUCPIONAba=aSim AS ABOVE
Name of Contractor and Job Foreman
487584 Business Address
Telephone No.
12300
Contractor's License No. City Business License No.
West American Insurance 0c).
BZW (93) 50364647
Applicant's Insurance Company
Policy Number
FEES: Juboivision 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 $ 7, C>
Permit Fee /0
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30
Receipt No.
Received by Date
Recorded by
PERMIT NO.
PERMIT VALIDATION
DATE APPROVED \
EXPIRATION DATE
DATE ISSUED
By
Administrative
TELEPHONE: (619) 564-2246
NN