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1840
't NOTE: 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: 8/16/93 LOCATION OF CONSTRUCTION $3-120 Ave Martines Subdivision Improvement Permit — Class III Minor Improvement Permit Class IV (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driv a 9,VVZOAli•h 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 PER RI WIDE County st4 ;# 207 I. &--n41416k r 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) In consideration of the granting of this permit, the applicant hereby agrees to: Indemnify, -defend and save the City, its authorized agems, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or couet 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 necessary as the result of this work. Signature of Applicant or Agent David Rosa Miller P© Box 922 1A Quint& 342--RA63 -- Name of Applicant (please print) Business Address Telephone No. Paefie Trades Dev r Name of Contractor and Job Foreman Business Address Telephone No. On F110 0a 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 constriction 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. 20.00 10.00 $ 30.00 Received by Date 1840 PERMIT VALIDATION PERMIT NO. *111II&A 1240 DATE APPROVED 8/16/93 EXPIRATION DATE 8/23/43 DATE ISSUED 8/16/93 By hlfe"-tupo Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 . ,.. r -- -. -- " - � .k .� ..� r .� NOTE: With proper validation this form constitutes an encroachment Permnt 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:(k, C( 3 Subdivision Improvement Permit — Claw 111 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION S 3 (z,0�;�. L �a2� (Strout address or Oearnpuon of Location) PURPOSE OF CONSTRUCTION A a VP 20ALs,-N- Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION .�•._ DIMENSION OF INSTALLATION OR REMOVAL - v SIZE OF EXCAVATION, IF NEEDED �y APPROXIMATE TIME WHEN WORK WILL BEGIN�� N o .J APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST S —, 7 (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: Indsmnifv. defend and rave the City. its authorized asanq. oNkcan, or p, harmless from and against and repttrsentatnes arrsplpyeonal any and all Penalties, liabilities or loci resulting from daunt or court action snd cress' Out of any aCGdalots happening or occurring as a pmxwnate reach of any wort undertaken under the Oartmrt dsmaPersons Or Dropyrty granted pursuant to thiss apo plication. Notify the Administrinnot Authority at feast tvuantr•four (24) hours in advance of the lima when wort will be ttartad. COMMY with all SPIPIkabie Cit, Ordinanep. the terms and eondit' of the La Ouints and to pay for y additional reptecas:wv a acem9m n pattnR and all applicabr MY 0 rola and regulations of the City of s the It of S cits ��« p � Signature ot�-Z2nt or Agent Name of Applicant (please print) Business Address j l� L2\r l L ��- S Telephone No. Name of Contractor and Job Foreman Business Address ' Telephone No. Contractor's License I - S_ I S � S City Business License No. F9fJ9 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. a S Received by Recorded by t PERMIT VALIDATION PERMIT NO DATE APPROVED . EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE: (6191 564.9?4R