1930NOTE- .
With proper validation
IfIt this form constitutes an CITY OF LA QUINTA .
encroachment permit
APPLICATION -FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
N r
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots sevv,,ers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED S• DIVISIONS
10/14/93 Subdivision Improvement Permit — Class II I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-200 AVE= NDNZ13=14A, LA QUINTA
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Y APPROACH
Sketch -(attach construction plans
if appropriate)
DESCRIPTION OF CONSTRUCTION
,PER RIVERME COUNTY
STD. NO. 207
(AT ACIND)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
D
10/15/93
I.
OCT 14
1993
APPROXIMATE TIME WHEN WORK WI LL BEGIN
APPROXIMATE TIME OF COMPLETION
By
'
ESTIMATED CONSTRUCTION COST $ 60.00
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
y
V
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 nd all app.ucable rules and ,eg lations of the City of
La Quinta and to pay for any additional replacement necessary as the result fis wo
i
Inure of Applicant or Agent
DODCO CONSTRUCTION SERVICE P.O. BOX 1012. LA QUINTA, CA 564-6478
Name of Applicant (please print) Business Address Telephone No.
SANB
Name of Contractor and Job Foreman Business Address Telephone No.
397 830 1375
Contractor's License No. City Business License No.
ON FILE ON PILE
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 schedule900
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
20,00
10.00
$ 30.00
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1930
DATE APPROVED 10/14/93
EXPIRATION DATE 10/22/93
DATE ISSUED 10/14/9
�-BY �..-'
/ Administrative aAhority
TELEPHONE: (619) 564-2246
P"rM
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
Y`
DATE: Subdivision Subdivision Improvement Permit — Class 111
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Q ',200 >l ye-
(Street
e(Street address or Oescription 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
ESTIMATED CONSTRUCTION COST $ SOU
(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:
Sketch (attach construction plans if appropriate)
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, toss or
damagehappening of occurring as a proximate result of env work undertaken under the permit granted pursuap Persons or propersy
nt to this tpplieatton.
Notify the Administrative Authority at least twentV`four (241 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 Ouinta and to pay for arty additional replacement neceauM as the result of this work.
Name of /jpplicant (please print)
Name of Contractor and Job Foreman
39 ?- - A.!?n
Contractor's License No.
Signature of Applicant or Agent
Business Address
TelepTtone No.
Business Address Telephone No.
?S
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subolvislon 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
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
1 vC:�J
Received by Date BY
Administrative Authority
Recorded by TELEPHONE: (619) 664.2246