2067'NO*: �
With proper validation Q'
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
96
Subdivision Improvement Permit — Class I I I
DATE: 2'16-94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78-749 Sagebrush
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION install driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION per Riverside County Std #207
(attached)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 2-18-94
APPROXIMATE TIME OF COMPLETION 2-24-94
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 pe it and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result ofis v� rk.
I ��,VA
Signature of Appricant or Agent
Bob Gripes 78-605 Sagebrush LA Quints CA, 92253 564-3098
Name of Applicant (please print) Business Address Telephone No.
A Ram Concrete #8— 405 Los Coyotes Indio ,CA 92201
Name of Contractor and Job Foreman Business Address Telephone No.
445758
Contractor's License No.
1295
City Business License No.
State Fund 677579
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
Permit Fee 10
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30
Receipt No.
Received by Date
Recorded by
FEB 16 1994
:20B1
PERMIT VALI ATION'
PERMIT NO
DATE APPROVED
EXPIRATION DATE
2067
2-16-94
2-25-94
DATE ISSU D —16-94
4A 1*1�_
By
Administrative Authority
TELEPHONE: (619) 564-2246
_- — ------------------------------------------------------------------
NOTE: ,
With proper validation
this form constitutes an CITY OF LA OUINTA
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:��
LOCATION OF CONSTRUCTION
— 7,4e9
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION AA0 A�
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
IF�?� vr2S.,DQE Loin- r7
x:& zG 7.
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debri , 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 lou 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 124) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the pei and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of t r .
Signature of Applicant or Agent
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address ,!/Q%o Telephone No.
Contractor's License No. City Business License No.
� ,z�O7- t Np
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
O
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond:
if required
TOTAL:
$
Receipt No.
Received by Date
i
_ ......TION` .
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Recorded by. II TELEPHONE: (619) 564-2246
Administrative Authority
I
9
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GEORGE H. CHANEY CO.
Inspection Services
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DATE
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JOB NO.
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PROJECT DESC IPTIO
LOCA ,[
CONTRACTOR
WEATHER
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FROM TO
HRS
TOTAL
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THE FOLLOWING WAS NOTED:
1 11 _G �- vr►-,EA iv,^4_S,g _
COPIES TO:
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SIGNED
WHITE - CLIENT, YELLOW.- FIELD FILE, PINK - OFFICE FILE
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