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1843NOTE: 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 8/17/93 LOCATION OF CONSTRUCTION 54-190 Ave Obregon Subdivision Improvement Permit — Class III Minor Improvement Permit Class IV (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveaav A PrOACh Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION PER RIVERSIDE OUIVIRTY STD # 207 (ATTACHED) DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED e APPROXIMATE TIME WHEN WORK WILL BEGIN 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 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 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 Marvin L Jordan P.O. Box 228 La Quints 364-4447 Name of Applicant (please print) Business Address Telephone No. ML Construction Ome As Above) Name of Contractor and Job Foreman Business Address Telephone No. 343335 2051 Contractor's License No. City Business License No. Scottsdale Ins CLS 434493 Applicant's Insurance Company Policy Number (FEES: Subdivision Improvement Permit — Class I II 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 II Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by Recorded by 10.00 $ 30.00 Date PERMIT NO. 1843 PERMIT VALIDATION 1843 DATE APPROVED 8/17/93 EXPIRATION DATE 8/20/93 DATE ISSUED 8/17/93 By TELEPHONE: (619) 564-2246 Administrative Authority NOTE: With proper validation this form constitutes an CITY' OF LA QUINTA en roachment 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 w• DATE: - ?—/? % . 7 Subdivision Improvement Permit - Class 111 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION `may - / 9' 105) ,%7 !/!r � J31e G. 19, �Ui N T/q (Street address or Description of Location) PURPOSE OF CONSTRUCTION ©,W l V Sketch (attach constructiontans if appropriate) ppropriate) DESCRIPTION OF CONSTRUCTION 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: �� Vii✓ S f �� w�,1�-/ -51 I> -t=1:- -?,C>77 "-e-4j Indemnify. defend and save the City, its authorized agents, officers. representatives and amplolrm. harmless from and against any and all Penalties. liabilities or loss resulting from clams Or court action and arising Out of env accident, loss or happening or occurring as a proximate rewlt of any work undsrtsken under the �rn� t0 persons or property Permit granted Pursuant to this sppliatiOn. Notify the Administrative Authority at least twenty-four 1241 hours in advance of the time when waft will be aw n& Comply with all applicable City Ordinances. the terms and Conditions of the permit and all applicable rules and regulations of the City of Lo Quinti and to pay for say additional replacement necessary as the result of this work. Name of Applicant (please print) L C'0 TV ,q C/ e_ Fie N Name of Contractor and Job Foreman -?(-/.?-??.S'_ Contractor's License No co/ Sig ture of Applicant or, Agent 6x 2, Z Z_/; -OL" Business Address Business Address -L6 I/ - L/ Li'r -i Telephone No. l4 !�-G [/— yc/G� Telephone No. zo z-/ City Business License No. h+ S U k x 1v c t_ C� L S-,- Applicant's.� �j �� 9'� Applicant's Insurance Company Policy Number FEES: �ubawlslon 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 i D Penalty Cash Deposit -Surety Bond if required TOTAL:. $_� U Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. DATE APPROVED - 7 EXPIRATION DATE DATE ISSUED -- ' /-7 13 By Administrative Authority TELEPHONE: (619) 564-2246 • k,