2026NOTE: "
With proper validation
this.forni constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
0
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: 12/29/93
LOCATION OF CONSTRUCTION 53260 AVE BUBIO
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION CONELM 43MM LY FM
MMT DOOR TO CM
DESCRIPTION OF CONSTRUCTION 12'X4' OF SIDEWA%[
IA CITY BIGHT-0F—WAY
Subdivision Improvement Permit —Class I II
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
0
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION "Oum ! — I a- 11)y
ESTIMATED CONSTRUCTION COST $ 96.00
(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 wort: 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 ulN
es nd regulations of the City of
La Quinta and to pay for any additional replacement necessary '2s-b,P resultkof this work. k
Signature of Applicant or Agent
D0117" V. BALL 7"91 VELIH Vff. SUITE 1. PALK DffiMT. CA 341--6088 (W=)
Name of Applicant (please print) Business Address Telepl `. 46 (HHB)
O NWBU ER
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
0
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
20.00
Permit Fee 10.00
Penalty s�
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
2026
PERMIT VALIDATION
PERMIT NO. 2026
DATE APPROVED 12/29/93
EXPIRATION DATE
01/07/94
DATE ISSUED k;/29/93
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
°fii' 0r«
NOTE:
With 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
LOCATION OF CONSTRUCTION
(Street address or Uescription of Location)
PURPOSEn F CQN
C�
�RNST''UC �' D✓ /hl'✓/oLe � SiGI, � �4 IK
DESCRIPTION OF
/2`. V.
SIZE OF EXCAVATION, IF NEEDED A)0,011-
-
APPROXIMATE TIME WHEN WORK WILL BEGIN Z
73571 is
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
APPROXIMATE TIME OF COMPLETION 1 4, / 3/ / -'
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, co
paction and placing permanent resurfacing and/or replacing improvemen si ► _
In consideration of the granting of this permit, the applicant hereby agrees to:
Sketch (attach construction plans if appropriate)
r N
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 conditis of the permit and all applicable rules a reg lations of the City of
La Quinta and to pay for any additional replacement necessary as the t of this work.
Signature of Ap cant or Agent
Name of AppFitapt (please print)
r
Name of Contracto and Job Fore an
Contractor's License No.
ith
Business Address
Telephone Nob %,
Business Address 7 /Telephone No.
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 $ 0,0
Permit Fee /10
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:.
$ 30
Receipt No.
Received by Date
2006
PERMIT VALIDATION
PERMIT NO. �� 2
DATE APPROVED'
EXPIRATION DATE
f
DATE ISSUED
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
i
f DOUGLAS V. RALL
CERTIFIED PUBLIC ACCOUNTANT
74-991 VELIE WAY, SUITE 1 OFFICE 619 341-6088
PALM DESERT, CA 92260 FAX 619 341-5317 j
i