1960With proper validation
thisorm constitutes an
encr achment 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: 11/8/93
LOCATION OF CONSTRUCTION AND OBREGON
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION HAS' TREKS
DESCRIPTION OF CONSTRUCTION CLSAN RIGHT OF KAY
DIMENSION OF INSTALLATION OR REMOVAL 11' VIDE,
70' LONG, CAT 980 LOADER KITH RAKE
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 100
(Including removal of all obstruction, materials, and debris, backfilling, com-
action and placing permanent resurfacing and/or replacing improvements) _
Sketch (attach construction plans if appropriate)
RAUL ROUTE: OBREGON TO HIDALGO
TO BERMODAS TO SLNALOA TO
AVE 52 EAST TO CITY LMTS
HA4VDATE: t11/8/93 -
Q
D
Nov 0 s 1993
By --�:�. -
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 result of this Wrj.
Slgn ture o Applicant or Agent
F.J. STOKEL.LS, JR. P.O. BOX 1059, Milo, CA 776-1359
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
Contractor's License No.
Business Address
Telephone No.
City Business License No.
CAL FAMI 0715193
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
Inspection Fee $
Permit Fee 10
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 10
Date
9
1960
PERMIT VALIDATION
PERMIT NO. 1960
DATE APPROVED 11/8/93
EXPIRATION DATE 11/8/93
DATEJvi
IS IED11/ /93
B
Administrative Authority
TELEPHONE: (619) 564-2246
��1
COTE: .
h proper validation
this form constitutes an CITY OF LA QUINTA
en'4roachment 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: /
LOCATION OF CONSTRUCTION—LlLLlL
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTAL�LATIQN C}R REMOVAL//
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
60� 1�cerm(- "0
to to vC
6 G 7r rv�
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 of the permit and all applicable rules and regulations of the City of
La Ouinta and to pay for any additional replacement necessary as the resin of thisAvoylj%
I-/ %A % b 2`2 M/ 0.
Name of Applicant (please print)
Name of Contractor and Job Foreman
Contractor's
,_� lSig6ature of Applicant or
Business Address
Business Address
Telephone No.
Telephone No.
City Business License No.
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
Inspection Fee $
Permit Fee _
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
$ /6
Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
Recorded by I TELEPHONE: (619) 564-2246