1882i
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
Subdivision Improvement Permit —Class I I I
DATE: 1117/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-050 Mendoza, 52-155 Navarro, 52-600 Martinez, 52-865 Velasco,
52-950 Rubio, 52-355 Navarro, 52-695 Rubio, 52-445 Rubio, 52-250 Obregon, 52-070 Madero
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION PER RIVERSIDE COUNTY SID # 207
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 9/17/93
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 2000.00
(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
Coachella Valley Housing Coalation 347-3157
Name of Applicant (please print) Business Address Telephone No.
Owner/Builder
Name of Contractor and Job Foreman Business Address 7,+ Telephone No/.
.- -1
Contractor's License No. # City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs i
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule 1 882
Inspection Fee $
boa
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 1-10
Date
PERMIT VALIDATION
PERMIT NO. 1882
DATE APPROVED (?— /7^ q3
EXPIRATION DATE /0 _I �p 13
/
DATE SUED 9-17— 7— % j
By
Administrative Authority
TELEPHONE: (619) 564-2246
With priPper variation
this form constitmes an
encroachment oermit 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:-- — / 7 Subdivision Improvement Permit — Class 111
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION ��SD �7eNdo z.4• — s� -� j s" /1//�(Jf}/�ic?
'2-k&{ e�(4sCo — So ,VOL(
(Street address or Oescription of LocnmjM 52 -a S- o O & I-, ,14A( _o , p p U o
PURPOSE OF CONSTRUCTION. J01, i U e /#_)« �, �l �,ac c 1^ Sketch (attach construction 1 f
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 COSTS %,��•
(Including removal of all obstruction, materials, and debris, backfilling, com.
paetion and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
a p ins I appropriate)
C-"tc
1 �
I �
Indammfy, defend and rave the City, its wthorizad agents, officer. rspreeentlitives and employees. harmles from and against any and all
Penalties' liabilities or loss resulting from dsum or court action and arising out of any accwent, loss or
happening or ooeumng es a proximate result of any wort undertaken undertaken under the permit granted pursuant to this applimiage to aotrtq « D��
Notify the Administrative Authority at least twenty-four 1241 hours in advance of the time when wort will be staRaO.
Comely with all applkable City Ordinances. the terms¢ and Conditions of the permit and all aopli :able rules and regulations of the City of
tJ Quints and to pay for any eddltlonal ntplacement necessary as the result of this work.
l'OACkeLL.ia 0/,LUeti k4ouSin.
Name of Applicant (please pfir`
Name of Contractor
no jou foreman
Contractor's License No.
Signature of Applicant or
i 4 �, Onl
Business Address
Telephone No.
Business Address Telephone No.
City Business License No.
Applicant's Insurance Company Policy Number.
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
S
a
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
l