1822NOTE:,U t
With proper validation
f .. 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
Subdivision Improvement Permit — Class I I I
DATE: 7/30/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-310 Juarez
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION DXivewaybigroach 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
RIVERSIDE COUNTY STD # 207
(ATTACHED)
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ fl
(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 app icant hereby agrees to:
Indemnify,
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any -,aid 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 worc 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 ne:essary as the result of this work.
Signature of Applicant or Agent
NII. Construction P.O. BOx 228 La Quinta 564-4447
Name of Applicant (please print) Business Address Telephone No.
Marvin:,Jordan Same
Name of Contractor and'Job Foreman Business Address Telephone No.
343335
Contractor's License No.
2051
City Business License No.
Scottsdale Ins CLS 474091
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:
Receipt No.
Received by
Recorded by
$ 80.00
10.00
$ 30.00
Date
022
PERMIT VALIDATION
PERMIT NO. 1822
DATE APPROVED 7/30/93 p /G
EXPIRATION DATE o
DATE ISSUED - 7/30/93
gy .l'Yl 6t�_
. Administrative Authority
TELEPHONE: (619) 564-2246
41 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: 7 -3o ` 9 3 Subdivision Improvement Permit — Class III
_ Minor Improvement Permit Clan IV
LOCATION OF CONSTRUCTION — S �� 3 / O J v /?-r= Z
L' 1-2 00//V%/9
(Street address or oesenption of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if
_ p appropriate)
DESCWTION OF CONSTRUCTION I Ii W h9 Y
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(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 &gaits, officers, reprasenatives 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
happening or occurring as a Pro:imete result Of any work undpermit granted pursuant to this application.damage
Notify the Administrative Authority at least twenty-four 1241 hours in advance of the time when work wiil be started.
Comply with all OPWicebla City Ordinances, the terms and conditions of the permit and all appikaWs rules and regulations of the Clty of
La Quints and to pay for any additional replaeemOm neatsssn, as the result of this work,
L
C
Name of Applicant (please print)
/I2/�le v/ /v J e n N
Name of Contractor and Job Foreman
31-/33 s
Contractor's License No
Q
Signafure of Applicant or Agent
J� O 13ax Z
Business Address
pe 13 G.Y L Z l✓ L 1?
Business Address
Telephone No.
V U 1 /'VIA SSG 4/ — ti N
Telephone No.
.;za /
City Business License No.
- ..., If
Applicant's Insurance Company H i If vPolicy Number
FEES: $ubmvlslon 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
Administrative Authority