2064F
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 imp ovements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE" 2-/.15/94
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S4-,295 Mendoza
r
(Street address or Descriptio,n of Location) ,
PURPOSE OF CONSTRUCTION Cut Curb for Dtiveway
DESCRIPTION OF CONSTRUCTION Cut Curb
DIMENSION OF INSTALLATION OR REMOVAL Curb 22'
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 2/17/94
Sketch (attach construction plans if appropriate)
0
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST 820.00 x
(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:
Attached Riverside County
Standard #207
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.
Signature of Applicant or Agent
Victor Pinson 85-624 Calle Limon Coachella, CA 398-1490
Name of Applicant (please print) Business Address Telephone No.
As Above
Name of Contractor and Job Foreman
B 675422
Contractor's License No.
Crusader Insurance Co.
Applicant's Insurance Company
Business Address
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 $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by
Date
Telephone No.
2934
City Business License No.
CIC 717089
PERMIT NO.
Policy Number
20
V _� Ll
FE915 1994
By_�-,
PERMIT VALIDATION
20664
DATE APPROVED 2/15/94
EXPIRATION DATE 1/20/94
DATE ISSUED 2/15/94
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
_W -i---------------------.------------------- ------------------------
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
DATE: 2� �6e1�
LOCATION OF CONSTRUCTION S
(Street address or Description of Location) (�
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION C
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE,TIMEIWHEN WORK WILL BEGIN
Subdivision Improvement Permit —Class II I
Minor Improvement `Permit Class IV
dsI
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 2
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 Quinta and to pay for any additional replacement necessary as the result of this work.
Signa re of Applicant or Agent
2_y Lk. ��i� Iq
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
61
Contractor's License 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 $
Permit Fee
Penalty
Cash Deposit -Surety Bond:
if required
TOTAL:
Receipt No.
Received by Date
Recorded by.
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564.2246
Administrative Authority
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