2004PO
- NOTE:
ttWith 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 I I
DATE: 12/7/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-460 MADSRO
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION DRIMAY APP110ACH Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION per Riverside Co. Std 207
+(attached)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 12-9-93
APPROXIMATE TIME OF COMPLETION 12-11-93
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
D Q �
DEC 2 2
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 th p,+ ii�and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result pf this work.
licant or Agent
Fred Sturner 52-531 Navarro La Quints, , CA 564-1822
Name of Applicant (please print) Business Address Telephone No.
Desert Concrete Const. 71-898 Hwy 111 Rancho Mirage, CA 92270
Name of Contractor and Job Foreman Business Address Telephone No.
482233
Contractor's License No.
continental
2939
City Business License No.
93cbp06156604-94
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3°/s, 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
Recorded by
$ 20
10
$ 30
Date
t
2004
PERMIT VALIDATION
PERMIT NO. 2004
F
DATE APPROVED 12-9-93
EXPIRATION DATE
DATE ISSUE -.D 12-9-93 r
BY
4ffdministrative Authority
TELEPHONE: (619) 564-2246
NOTE:
Viiith 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 I I
DATE: V-2J6,ci'� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION ' 60
(Street address or Description of Location))
PURPOSE OF CONSTRUCTION I�����A--`P
DESCRIPTION OF CONSTRUCTION '5I 06L� '��
jZ,1=,`moi 0�1JC.�
DIMENSION OF INSTALLATION OR REMOVAL �®
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME WHEN WORK WILL BEGINC4 Li
APPROXIMATE TIME OF COMPLETION GC_ —7 I 3
ESTIMATED CONSTRUCTION COST $ `Z��•G
(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 savep 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 a applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of t is wo
Signature of Appli nt or Agent
Name of Applicant (please print) Business Address Telephone No.
I
Name of Contractor and Job Foreman Business Address Telephone No.
405_2z 1:71 -
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
1936
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
!9