2048NOT NE_
,,With proper validation
this form constitutes an
encroachment permit
PUBLIC
CITY OF LA QUINTA
APPLICATION FOR PERMIT
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: 1/27/94
LOCATION OF CONSTRUCTION 54545 DIAZ
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1/27/94
APPROXIMATE TIME OF COMPLETION 1/29/94
ESTIMATED CONSTRUCTION COST $ 100.00
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
PER RIVERSIDZ CO. STD #207
ATTACHED
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 r uIt of this work.
Si nature of Applicant or Agent
HAMILTON MASONRY P.O.BOB 1771
Name of Applicant (please print) Business Address Telephone No.
SAME
Name of Contractor and Job Foreman Business Address Telephone No.
591684 1631
Contractor's License No. City Business License No.
On File On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class II I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs l �/
Minor Improvement Permit — Class IV: See attached schedule {
20 2048
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10
$ 30
Received by Date
PERMIT VALIDATION
PERMIT NO. 2048
DATE APPROVED 1/27/94
EXPIRATION DATE
2/04/94
DATE I �UE F 1/ 7/94
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
r'
a�
f�
?il
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
DATE:—/— % _ _ Subdivision Improvement Permit —Class II I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Z7'Z/S'Z/S DzfZ_
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION T7
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETIO (— Zq— ci y
ESTIMATED CONSTRUCTION COST $ W • 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 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 work.
1741 /L! 0-11 AMORli I --
Signature of Applicant or Agent
Name of Applicant (please print)
Name of Contractor and Job Foreman
279 1 to i? y
Contractor's License No.
Business Address
Telephone No.
Business Address Telephone No.
v /&3 /
City Business License No.
'Applicant's Insurance Company /Policy Number
FEES: Subdivision Improvement Permit — Class II 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 $ Z �I
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
/P
$ _gv
Date
2®06
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED /-0 7 g�
EXPIRATION DATE Z , U q
DATE ISSUED / .2— 7 _ f
By
TELEPHONE: (619) 564-2246
Administrative Authority