1870NOTE: -°
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 II I
DATE: 9/7/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-765 Ave Ruiio
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Drivevay Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
PER RVERSIDE COUNTY STD # 207
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ARAV
APPROXIMATE TIME OF COMPLETION 9/14/93
ESTIMATED CONSTRUCTION COST $
(Includin 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:
pQ°D
SEP 0.7 1993 D
By
M
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 (241 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
MAchale Bangerter P.O. Box 59 La Quinta 564-1486
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
524325 1235
Contractor's License No. City Business License No.
On Bile On Bile
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class II I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit —Class IV: See attached schedule TO
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 20.00
10.00
$ 30.00
Received by Date
PERMIT VALIDATION
PERMIT NO. 1879
DATE APPROVED 9/7/93
EXPIRATION DATE 9/14/93
DATE SU D 9/7/93
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246 '
1
NOTE:
With proper validation
this form constitutes an
encroachment permit CITY OF LA OUINTA
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: :�J_— n Subdivision Improvement Permit —Class 111
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S6/ - '!D' -
(Street address or Oescnpnon of Location)
PURPOSE OF CONSTRUCTION �� r � � �� ►?���
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
IF—
SIZE OF EXCAVATION, IF NEEDED ►x I Qr I
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION - 21 -1 N-�I
ESTIMATED CONSTRUCTION COSTS
(Including removal of all obstruction, materials, and debris, badtfilling, com.
paction and placing permanent resurfacing and/or replacing improvements$
In consideration of the granting of this permit, the applicant hereby agrees to:
Indernmfy, defend and save the City, its authorised agents. offiprs. representatives and OMIOYM. harmless from and against any and all
penalties, iisbilities Or losa' resulting frorm clsums Of court action and wising out of any accident. loss or
happening or occurring as a prontinuts result of any wort undertaken undertaken under the damage to penoems or property
permit granted pursuant to thio apOlieation.
Notify the Administrative Authority at least twenty-four 124) hours in advance of the time when wort will be started,
Comply with all apolieable City OrdilMum, the terms and conditions of the permit and all applicable rules and requlatiom of the City Of
V Quints and to pay for any siWitlonal "AIM writ necesory es the result of this wont,
M
of Appl
Name of Contractor and Job Foreman
Ec1 -Z -,::;-
Contractor's License No.
A] kll—IF
Applicant's Insurance Company
Business
Business Address
I//
Telephone No.
Telephone No'.
City Business License No.
Policy Number
FEES: Subaivision Improvement Permit —Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor improvement Permit — Class IV: See attached schedule
Inspection Fee S �0
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ .30
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. %D
DATE APPROVED 6 7-1 3
EXPIRATION DATE 9— /Y ?3
DATE ISSUED - q 7— 73
By
Administrative Authority
TELEPHONE: (619) 564.2246
ti