19481
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
Subdivision Improvement Permit —Class II I
DATE: 10/29/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 32-713 AMM B=MW
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL IS x. Z011
SIZE OF EXCAVATION, IF NEEDED I
Ey APPROXIMATE TIME WHEN WORK WILL BEGIN 10 29 93 93
APPROXIMATE TIME OF COMPLETION 3 DAYS
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) hoursinadvance 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 ~result of this work.
Signature d'Applicant or Agent
DAVID ROSS NWjM P.O. BOX 722, 1A QUINTA, CA 362-8363
Name of Applicant (please print) Business Address Telephone No.
PACIFIC TRAM s 03 SAM
Name of Contractor and Job Foreman Business Address Telephone No.
8425381 1955
Contractor's License No. City Business License No.
YAM= IIISURAHCB P72398593
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 1948
Inspection Fee $ 24'00 PERMIT VALIDATION
Permit Fee I0•00 1948
HERMIT NO.
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
Received by
$ 30.00
Date
DATE APPROVED 10/29/93
EXPIRATION DATE 11/02/93
DATE ISSUED 10/29/93
Byc-��. 1
/ Administrative -Authority
Recorded by 11 TELEPHONE: (619) 564-2246
,It NOTE:
With proper validation
lthis 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 III
DATE: QI �9 I Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION S A �t
DIMENSION OF INSTALLATION OR REMOVAL X Zo
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION ? D °r"iS
ESTIMATED CONSTRUCTION COST $ 300
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction plans if appropriate)
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 It of thi . work.
` r
Signature of Aplicant or Agent
_L
Name of Applicant (please print) Business Address Telephone No.
'�RA Lk 1Z 'k L c�, C) S P, Z S A,
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 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 $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
1936
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
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