1873r$hOTE:
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: September 8* 1993
LOCATION OF CONSTRUCTION 52-700 Vslleio
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway 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 x/93
APPROXIMATE TIME OF COMPLETION 9/10/93
ESTIMATED CONSTRUCTION COST $ 500
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Por 8ivorsido Co. Std. 207 (attached)
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 theiltof
result of this work.
6 i
Signature of Applicant or Agent
William Doran $2-700 V'a1lltjoa La Quiutas CA :922,53 5642018
Name of Applicant (please print) Business Address Telephone No.
Al Dov i G
Name of Contractor and Job Foreman
576960
Contractor's License No.
Business Address Telephone No.
2876 /
City Business License No. ,
On File Ott Fila
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III N.
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
10
$ 30
Date
Uj
18j
PERMIT VALIDATION
PERMIT NO. 1873
DATE APPROVED
9/8/93
EXPIRATION DATE 9/10/93
DATE ISSUED 9/8/93
By
administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
i,
1
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, sewers, water rrmins
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Clan III
ATE:-- =`'� Minor Improvement Permit Class IV
,OLOCATION OF CONSTRUCTION. S Q 0 )IA -
(Street address or Oescnpuon of Loationl
%C PURPOSE OF CONSTRUCTION
01 x t 4 Sketch (attach construction tar: if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN _ : h
x APPROXIMATE TIME OF COMPLETION — x7,
/ 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:
Indamnifv, defend and save the City, its authorized sgonn, office". representatives and employees, harmless from and against any and all
Penalties. liabilities or loss resulting from cisam or court action and arising out of any accident, loss or
happening or occurring es a proximate rewlt of any wort unde"aken under the darnage t0 persons O/ property
permit granted pursuant to this appticetion.
Notify the Administrative Authority at least twenty-four 124) hour in advance of the tiny when wort will be started,
Comdv with 811 appliceNs City Ordizusiv s, the tants and conditions of the permit and all apOliCsble rules and regulations of the City of
V Ouinta and to pay for any additional replaeartxrrtt necetsery as the result of this wort.
K_ - L ZA � �_) �61
Name of Applicant (please print)
Name of Contractor and Job Foreman
S-) ( 9600
Contractor's License No.
Signature of Applicant or Agent
Business Address
Telephone No.
Business Address Telephone No.
�_ a �� y
Clty Business License No.
icanrs Insurance t;ompany �ngLIjVgX?�� U 4gCuTy
FEES: Subaivision 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 $ �d
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by Date
Recorded by
Policy Number
PERMIT VALIDATION
PERMIT NO
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2248