1839NOTE:
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
Subdivision Improvement Permit — Class I II
DATE: 8/16/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 77-205 Calla Duxsango
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION brivAway AVIlrenAMn
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
PIM RIVSRSIDH COUM STD # 207
CM 6L&4�
f
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
s
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
I
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 ne--essary as the result of this work.
Signature of Applicant or Agent
David Rose Miller PO Boa 722 1A YQuinta 342-8363
Name of Applicant (please print) Business Address Telephone No.
Pacific Trade De (Same AQ above)
Name of Contractor and Job Foreman Business Address Telephone No.
B425381
Contractor's License No.
1955
City Business License No.
Farmers Ina 090956 93 88
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
tn.nn
$ 30.00
Date
1 839
PERMIT VALIDATION
PERMIT NO. 1839
DATE APPROVED 8/16/93
EXPIRATION DATE 6/23/93
DATE ISSUED 8/16193
By Tt ti e -J .
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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, sewer, crater mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE:.b 93, Subdivision Improvement Permit - Class 111
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION _ Z c1 C `R 2 b 6 �3
(Street address or Descnption of Location)
PURPOSE OF CONSTRUCTION -bFZ �� � A
ykQ P Moz-, lfi Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL _v�� __ y
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ►Jo
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS v .---
(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, officer. representatives and employees. harmless from and against any and all
penalties, liabilities or los resulting from claims or court action and arising out of any accident, loss or
happening or occurring'as a proximate result of any work undertaken under the permit granted pursuant to Uf�application. to person orp ropety
Notify the Administrative Authority at least twenty-four 1241 hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions..' the permit and all applicable rules and
La Ouinte and to pay for carry additional neplaeemertt n regulations of the City of
necessary as tha t of th' work.
r
SS
k Signature of Alicant or Agent
, �,0 ��`� � , o , Ix 1z ��& 3C+ —F3;_ --�,
Nalme of Applicant (please print) Business AddR. C\ l L -4-� k 6 �S J, Telephone No.
Name of Contractor and Job Foreman Business Address
Telephone No.
Con,titactor's License No. ^ City Business License No.
�-5 o°c S-� Ct 3 Y
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 $
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
Administrative Authority
TELEPHONE: (619) 564-2246
I I I fl, . f