1940With 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: October 21, 1993
LOCATION OF CONSTRUCTION 54-040 Avenida Ramirez
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 County Std. 207 (attached)
DIMENSION OF INSTALLATION OR REMOVAL' Y. i
t
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 10/22/93
APPROXIMATE TIME OF COMPLETION 10/23/93
ESTIMATED CONSTRUCTION COST $ 300.00
• I d b • b kf•II•
D Q '} I
OCT 21 19,93
By
(Including removal of all obstruction, materia s, and a rls, ac i mg, 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 applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the re drt bf this work.
ignature of Applicant or Agent
Mumbil, Inc. P.O. Boa 1555 La Quints, CA 92253 564,--8
Name of Applicant (please print) Business Address Telephone No.
Bill Howard Same
Name of Contractor and Job Foreman Business Address Telephone No.
537333 2526
Contractor's License No. City Business License No.
Scottsdale Insurance Company GLS 499425
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule 1.940
Inspection Fee $
Permit Fee _
Penalty _
Cash Deposit -Surety Bond
if required _
TOTAL
Receipt No.
Received by
20.00
10.00
$ 30.00
Date
PERMIT VALIDATION
PERMIT NO. 1940
DATE APPROVED 10/21/93
EXPIRATION DATE 10/25/93
DATE ISSUED in 21.141
By_`0
_`0?6"_ Administrative Authority
Recorded by I TELEPHONE: (619) 564-2246
�f f'
NOTE:
Ah 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: / Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION '4Z0 4o tto— RPcYrl I1& 2
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION I 1 (o Sketch (attach construction plans if appropriate)
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 $
(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 ol,01-5-e�rnit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as ihe/fesultpf this work.
Name of
) LL_
(please print)
7weArkC>
ature of Applicant or Agent
Business Address
S �rns�
Lk
Telephone,No.
J?3
Name of Contractor and Job Foreman Business Address Telephone No.
Co factor's License o. 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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by Date
1936
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246