2019NOTE:
With proper validation
f this form constitutes an
P� 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 II
DATE: 12/21/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-195 AVE MADERO
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DRIMAY APPROACH
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
PER RIVERSIDE CO. STD. #207
(ATTACHED)
DIMENSION OF INSTALLATION OR REMOVAL 6' a 70'
SIZE OF EXCAVATION, IF NEEDED SAMB
r
APPROXIMATE TIME WHEN WORK WILL BEGIN 12/21/93
APPROXIMATE TIME OF COMPLETION 1 VEM
ESTIMATED CONSTRUCTION COST $ 300.00
(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 advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions�,rf h4peraj�kall applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as thesu6L�
A. Signature of Applicant or Agent
DAVID ROSS MILLER P.O. BOB 722, LA QUIM, CA 342-8363
Name of Applicant (please print) Business Address Telephone No.
PACIFIC TRADES DEV. SAME
Name of Contractor and Job Foreman Business Address Telephone No.
B425381
Contractor's License No.
FARMERS
Applicant's Insurance Company
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 $ 20.00 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTA L:'
Receipt No
Received by
10.00
$ 30.00
Date
1955
City Business License No.
Policy Number
x
2
DEC 21 1993
PERMIT VALIDATI
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
2019
12/21/93
12/24/93
DATE ISSUED 2/21/93
By al"p --
Administrative Authority
Recorded by , 11 TELEPHONE: (619) 564-2246
I
0
------------------ -- ---------------
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 III
DATE: (Z I Z I Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S Z — �S Av �-&4, j
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
k>cR.V ti w ra
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL X 7 .o
SIZE OF EXCAVATION, IF NEEDED 'C' et•C
Sketch (attach constructionlans if appropriate)
ppropriate)
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION L
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:
s'r'%— Zo 7
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 ins advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions oft a permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the resul of this work.
S
\ Signature of App 'cant or Agent
�X -I-z- I C_, & c U� 3yz- 3�z
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
9 Z-1?-) 10 �3 3
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 _
Recorded by _
$ _,�7p
Date
2®06
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE /Z
DATE ISSUED Z2—
By
TELEPHONE: (619) 564-2246
Administrative Authority
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