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1851'NOTES _s a 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 Subdivision Improvement Permit — Class III DATE: 8/24/93 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 53-160 Diaz (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION PER RIVERSIDE COUNTY STD # 207 (Attached) DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN p�aa APPROXIMATE TIME OF COMPLETION AUG �4 J993 ESTIMATED CONSTRUCTION COST $ l/ (Including removal of all obstruction, materials, and debris, backfilling, com- ay d 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 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 �anlj all applicrble rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as the re�Jx=o—thf is_work. Sig/W n/ature of Applicant or Age ntua_' __ - _` ---- Rusty Rhodes Ci�3� MOM,/ A-ra PL r 340-5091 5�%�- C�4 Q ZZIPI� Name of Applicant (please print) Business Address Telephone No. Owner/Builder Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business License No. 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 $ 20.00 Permit Fee 10.00 Penalty Cash Deposit -Surety Bond if required TOTAL: $ 30.00 Receipt No / Received by Date PERMIT NO 16651 PERMIT VALIDATION 1851 DATE APPROVED EXPIRATION DATE 8/24/93 8/27/93 DATE IS UE /24/93 By Administrative Authority Recorded by . 11 TELEPHONE: (619) 564-2246 ki NOTE: With proper validation this form constitutes an encroachment permit FA 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 111 DATE:---��/� � / 9--" Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION ��� i� d �! a 7 - (Street address or Description of Location) PURPOSE OF CONSTRUCTION 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) Sketch (attach construction plans if appropriate) RA �a(U"S),6.6 Co S 7r-> -* z -eq 7 C�D In consideration of the granting of this permit, the applicant hereby agrees to: If. Indemnify, defend and save the City, its authorized agents, officers, 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 of damage to persona or prope happening or occurring as a proximate result of any wort undertaken under the permit granted pursuant to this application. My Notify the Administrative Authority at hast twenty-four 4241 hours in advance of the tuna when work will be stared. Comply with 111 applkable City Ordinances, the urns and conditions of the permit and all applicable rules and regulations of the City of La Quints and to pay for any additional replacement nen2uw a:.w_ .__.,&...a- Name of A (Ant (please print) Name of Contractor -and Job Foreman Contractor's License" No. Address 3uiLbj,/,2_ Business Address Telephone Telephone No. City Business License No. Applicant's Insurance Company Policy Number FEES: $ubalvislon 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 $ z� Permit Fee / Penalty Cash Deposit -Surety Bond if required TOTAL: $ �G Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. DATE APPROVED . EXPIRATION DATE DATE ISSUED 611__1)L11q 5- q3 q/ 93 1%13x6 By Administrative Authority TELEPHONE: (619)564-2246 V11-