1887NOZE,:
With proper validation
this form constitutes an
encroachment permit
Il�
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
DATE: 9-21"99
LOCATION OF CONSTRUCTION 54-102 Ave Bermudas
(Street address or Description of Location)
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
PURPOSE OF CONSTRUCTION construct drive etnnroach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION cut rsideeaalk 6 curb per Riverside Co. Std 207 (attached)
4V.�
DIMENSION OF INSTALLATION OR REMOVAL 6X20
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 9-23-93
APPROXIMATE TIME OF COMPLETION 9-26-93
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:
pSEQ�j-� ,g��9 3 D
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.
I
Notify the Administrative Authority at least twenty-four (24) hours in advance o b e when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of th ermit and all a licable rules and regulations of the City of "
La Quinta and to pay for any additional replacement necessary as the resu of this work. �...-....�
Signature of Applicant or Age6"-0 '`
Paulden Evans P.O. Box 192 La Ouinta. CA 92293 564-3522
Name of Applicant (please print) Business Address Telephone No.
Name of.Contractor and Job Foreman Business Address Telephone No. .
652188
Contractor's License No. -
2392
City Business License No.
Premium Finance Corp PFC00919
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
10
$ 30
Date
1887
PERMIT VALIDATION
PERMIT NO. 1887
DATE APPROVED
9-21-93
EXPIRATION DATE 9-28-93
DATE ISSU D —21-93
By
/Administrative Authority
TELEPHONE: (619j.664>22�4'6"' -777„ 7073"
NOTE:
Wth proper validation
this form constitutes an
encroachment oermn 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 'trains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: 9? o — 9/3
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class 111
Minor Improvement Permit Class IV
M010 FAS / ?- P
9,1_454—el ;-=: A dill A) 1-4
(Street address or Oescnotion of Location)
PURPOSE OF CONSTRUCTION
[-If" fu ISFIV Uteri 0 1.1 IUt_ WAW --
DESCRIPTION OF CONSTRUCTION
en,iOwALL n"0 erg n�r" c Lm
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WOILL BEGIN
a_ ���
Sketch (attach construction plans if appropriate)
C
Co f> -TD- Zo7
APPROXIMATE TIME OF COMPLETION
'ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction, materials, and debris, backfilling, corn-
Paetion and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemve nify, defend and saw the City, its authorized agents, officers. reoresentativaand employee. harmlea from and against any and all
penalties, liabilities or Ion resulting from claw" or court action and Arising out of any accident, loss or
d&
ma" or occurringimpermit granted pun
ng d a pros;ate result of -ny wort undertaken under the his appliotion. to persons oa property
arant to this
Notify the Administrstne Authority at Nast twenty-four 1241 hours in advance of the time when work will be started.
Comply with all "Olicable City Ordinances, the term and conditions of the it all appli"WO MISS and IMistions of the City of
La Ouints and to pay for any additbnel reWaosmern neiasawy as the resin of this
� LX 0U_1V F VA N Signature of Applica.Agent G✓ 5
Name of Applicant (please print)
1l Business Address
Telephone No.
Name of Contractor and Job Foreman Business Address
Telephone No.
F LS 9 Z
Contractor's License No./ City Business License No.
0 0
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 9 b
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: S SCS
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564.2246
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