2066NG#E: .
With proper validation
Tis 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
2/15/94
LOCATION OF CONSTRUCTION 52-230 Avenida Diaz
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway SAProach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 2/16/94,
APPROXIMATE TIME OF COMPLETION 2/23/94
ESTIMATED CONSTRUCTION COST $ 300
(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:
Per Riverside County Std. 207 (Attached)
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 conditi of the p it and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the esult o th' work.
jS
Signature of pplicant or Agent
David Ross Miller P.O. Sox 722 La Quinta, CA 92253 342-8363
Name of Applicant (please print) Business Address Telephone No.
Pacific Trades Development . Same
Name of Contractor and Job Foreman Business Address Telephone No.
B425381
Contractor's License No.
Farmers INsurance
1955
City Business License No.
93-27095
Applicant's Insurance Company Policy Number , n I I r
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
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required `
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
FEB 15 1994
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
2066
2/15/94
EXPIRATION DATE 2/23/94 '
DATE ISSUED 2/15/94
By
Administrative Authority
TELEPHONE: (619) 564-2246
_..... ? -.... - -
NOTE:
%/ith 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
c Subdivision Improvement Permit —Class III
DATE: Z 5 / Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Z J � C -
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION. D q', J Sketch (attach construction plans if appropriate)
DESCRIPTION. OF CONSTRUCTION c rA 0A. S ,
DIMENSION OF INSTALLATION OR REMOVAL (0 2
SIZE OF EXCAVATION, IF NEEDED in)c W
APPROXIMATE TIME WHEN WORK WILL BEGIN �' h�
"LIIbtctL
APPROXIMATE TIME OF COMPLETION t w�
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, Aefend and save the City, its authorized agents, officers, representatives:end 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.
it� sof the permit an all applicable rules and regulations of the City of
Comply with all applicable City Ordinances, the terms and cond`5La Quinta and to pay for any additional replacement necessary as the It of thi wor c ^
Signature of ApIcant or Agent
Name of Applicant (please print) Business Address Telephone No.
1
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No..
24�tt V-\ �,2 l .-0S -
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
ond: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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