1929NOTE:
!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
Subdivision Improvement Permit —Class I II
DATE: 10/14/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 77"551 CALLS POTRERO, LA QUINTA
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION DRIVBil1AY APMACH Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION,
PER RIVMIDE COMM'STD. NO. 207
(ATTAC®)
DIMENSION OF INSTALLATION OR REMOVAL
"7
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
10/15/93 fi ' Ey T 1 993
APPROXIMATE TIME OF COMPLETIONESTIMATED CONSTRUCTION COST $ 600.00(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 applieabie rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this�w����"
DODCo.CONSTRUCTION SERVICE
Name of Applicant (please print)
gnature of Applicant or Agent
Business Address
564-6478
Telephone No.
. SM
Name of Contractor and Job Foreman Business Address Telephone No.
397 830 1375
Contractor's License No.
ON FILE
City Business License No.
ON FILE
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 $
20.00
Permit Fee
10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
30.00
Receipt No.
Received by
Date
Recorded by
1,929
PERMIT VALIDATION
PERMIT NO. 1929
DATE APPROVED 10/14/93
EXPIRATION DATE 10/22/93
ISSUED 10/14193
CDATE
B.y
Administrative Authority
TELEPHONE: (619) 564-2246
,t
t 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: ���93 Subdivision Improvement Permit — Class III
- Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION ( Sketch (attach constructiontans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION '.2 -Z
" �V_g a w K" — I &, (__0 ... f
DIMENSION OF INSTALLATION OR REMOVAL li ��� 0 -7i0 -1
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN - /0'/5_93
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ - l
(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 saw the City, its authorized sgmtts, officers, representatives and employees, harmless from and againstany end all
Penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or p nda all
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 Quints and to pay for any additional replacement necessary as the result of this work.
DDDco
Name of Aoo
(please print)
Name of Contractor and Job Foreman
Contractor's License No.
Signature of Applicant or Agent�
Business Address
Telephone No.
Business Address Telephone No.
1J Rs—
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Suborvision 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
2 a
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
E'er
$ 3�
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED l b — 1 4 - '�- 3
EXPIRATION DATE. 2Z"q 3
DATE ISSUED _ I `( -9-3
By
TELEPHONE: (619) 564-2246
Administrative Authority