1911i,NOTE:
Pith 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 III
DATE: 10/4/93 Minor Improvement Permit Class IV
r..
LOCATION OF CONSTRUCTION 54-945 HER88RA, LA QDI>NTA
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 16' a 16'
CONCRETE APPROACH
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 10/4/93
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 10/7/93
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:
PER RIVERSIDE CO. STD #207
�aTTAc�D)
D.
OCT 0 4 1993 '
BV4a____2
;
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, M,armless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, to 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 p mit and all appli le—rules ap<ggulations of the City of
La Quinta and to pay for any additional replacement necessary as the result f this work.
Signature of Applicant or Agent
EMM INGLE
Name of Applicant (please print) Business Address Telephone No.
JNK DEV=P2UWT, INC. 213/656-3153
Name of Contractor and Job Foreman Business Address Telephone No.
390684
Contractor's License No.
3396
City Business License No.
Scottsdale Insurance Co. GLS384718
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
1_91 1
PERMIT VALIDATION
PERMIT NO. 1911
DATE APPROVED 10/4/93
EXPIRATION DATE 10/7/93
DATE ISSUED /Q ^ ��
` Administpxdve Authority
TELEPHONE: (619) 564-2246
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 mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: za `-" /
LOCATION OF CONSTRUCTION
(Street address or Oescnpti&n of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 57 --
ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Subdivision Improvement Permit — Class III
/ Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
2GU% C�4�7_i4 tlX-OR)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and saw the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
Penalties. liabilities or loss resulting from daima or court action and a►ising Out of any accidenK, 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 aWliation.
Notify the Administrative Authority at least twenty-four 1241 hours in advance of the time when work will be started,
Comply with all applicsble City Ordinances, the terms and conditions of the Penn it and all applicable rules and regulations of the City of
Ls Quints and to pay for any additional replacement necessary as the result of th' work,
Signature of Applica or Agent
Name of Applicant (ease print)
Name of Contractor and Job Foreman
-,a- 169n(= z �z
Contractor's License No. I
Business Address
Telephone No.
Business Address Telephone No.
_ .2 _3 ?61
City Business License No.
L 41% l I I :L(A
Applicants Insurance Company Policy Number
FEES: Subalvision Improvement Permit —Class III Gql 1�1u7 t Sp F
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 Date
Recorded by
PERMIT NO.
DATE APPRO'
EXPIRATION
DATE ISSUEC
1 X86
PERMIT VALIDATION
By
Administrative Authority
TELEPHONE: (619) 564-2248