1821NOTE:
With proper validation
this form constitutes an
encroachment permit
�r
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
Subdivision Improvement Permit — Class II I
DATE: 7/27/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78-725 Ave La Jarita
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Drivewav Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
PER RIVERSIDE COUNTY STD ! 207
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED !rU
D
APPROXIMATE TIME WHEN WORK WILL BEGIN 8/15/93 0 1993
APPROXIMATE TIME OF COMPLETION 8/20/83} i
ESTIMATED CONSTRUCTION COST $ , By
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) f
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
0
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 advanje of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the ermit 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 wgrk.
SignatUre of Applicant or Agent
A & M CONST 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.
On File On File
Contractor's License No. City Business License No.
On File
On File
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
i
Inspection Fee $ 20.00
Permit Fee
10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
J
f'
PERMIT NO
1821
PERMIT VALIDATION
1821
DATE APPROVED
EXPIRATION DATE
7/30/93
8/20/93
DATE ISSUE !7/30/93
By !
Administrative Authority
TELEPHONE: (619) 564-2246
1 0
NOTE:
With proper validation
this form constitutes an
encroachment oermn CITY OF LA QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewen. water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
"M
DATE: July 27, 1993 Subdivision Improvement Permit - Class 111
Minor Improvement Permit Clue IV
LOCATION OF CONSTRUCTION 78-725 Avenida La.'Jarital La Otunta
(Street address or oesrnption of Location)
PURPOSE OF CONSTRUCTION -Drivew ay
DESCRIPTION OF CONSTRUCTION
IMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN Aug 15, 1993
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION - Aua 20 1993
ESTIMATED CONSTRUCTION COSTS 1165.00
(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:
P- v K4'5'-1 10*
Indemnify, defend and save the City, its authorized agents, offiom.POMItrepresentatives and err+olovees, hammier from and agairgR any and all
happeninft.g
liabilities Or In rpuxuTN from damp or Court wtwn and arising out of any accident, lots or darruip to persona or property
nappenirq or occurring n a prpamrte readmit of any wort undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twanty-four 1241 ham in advance If the time when work will be narted.
Comply Math all applieabla City Ordinancef. the terms and Conditions of the mnrt and all applicable ruin and regulations of the City of
V Ouinte and to pay for any additional nplacerment neonwV as the result this work.
Signaturil of Applicant or Agent
A&M �STRUCrION P-0- Y 366-7 070 Calle-Cadiz- La Mint: CA 9225
Name of Applicant (please print)
564 48�
Business Address Telephone No.
Name of Contractor and Job Foreman
487584
Business Address
Telephone No.
12300
Contractor's License No. City Business License No.
West American Insurance Cb. 8LW (93) 50364647
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 $ - 2-61
Permit Fee ky
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ - C7
Receipt No.
Received by Date
Recorded by
L_
PERMIT VALIDATION
PERMIT NO
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
y{ Jr