Loading...
1898A 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 DATE: September 280 1993 LOCATION OF CONSTRUCTION 53-600 Eisenhower Subdivision Improvement Permit— Class III Minor Improvement Permit Class IV (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION PER RIVERSIDE COUIM DIMENSION OF INSTALLATION OR REMOVAL STD #1207 (ATTACHED) SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION 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: 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. fi 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 th permit and all applicable rd a and regulations of the City of La Quinta and to pay for any additional replacement necessary as the resu4 of this work. j �AN SiWna re of Applicant or Agent Scott M. Jones 1.0. Box 2974. Palm Dose CA 92261 564-2691 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 ffD r 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 20.00 10.00 $ 30.00 Date P 2 8 1993 LL 1M By PERMIT(VALIDATION PERMIT NO. 1898 DATE APPROVED EXPIRATION DATE 9/28/93 10/11/93 DATE ISSUED 9/28/93 By o Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 v ) Wth pri � r validation the fo;; constmrtes 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 mons and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS %/2/n� 3 Subdivision Improvement Permit —Class 111 ATE:- Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Stmt address or Oesawtion of Location) 0< PURPOSE OF CONSTRUCTION /100L 60AX0,fCH Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION 9EM006- .QY G F or 1r(5T'tcc) 11/140y4K �E=_Pouic Cush s CurrE2 IeE/110ve- SI Lr % le -11100f2 70 e,OKFORM DIMENSION. OF INSTALLATION OR REMOVAL 2q c r c 74 i EK,ge7c 51 r So� wg�K SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN _243,91i, APPROXIMATE TIME OF COMPLETION /0 ESTIMATED CONSTRUCTION COSTS /500'—'0' (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: Q4 Rt/u, � �SU *D4 -7 fi d) Indenimfy, defend and save the City, its authorized agents, officers. rep "t8tiws and ernplOyea, harmless from and against any and all penalties, liabilities or Iota resulting from damns OfCourt 111=10n and arising Out of any accident, loci or happening or octumng a a pmxirrsta reeYlt Of a work u darnage to PliniOms or property any nd0 ken under the permit granted pursuant to this application. Notify the Administrative Authority at least twenty-four 1241 hours in a Comply with all applicable City OrdUuwN e, the term and Condition Of La Quints and to pay for any addltkntal replacement neck, as the ni ©" & U�Ll15'/cp67` JOAte-� Name of Applicant (please print) Name of Contractor and Job Foreman Contractor's License No. EM of the time when work will be stared. -it and all applicable this work. , of Applicant or 9 7q PD Business Address and regulations of the City of 5X el Telephone No. Business Address Telephone 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 $ a Permit Fee O Penalty Cash Deposit -Surety Bond if required TOTAL: $ 3o Receipt No. PERMIT NO. DATE APPRO' EXPIRATION DATE ISSUED PERMIT VALIDATION Received by Date By Administrative Authority Recorded by TELEPHONE: (619) 564.2246 „� Jin+”-1�