2081NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
x
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: 2/24/94
LOCATION OF CONSTRUCTION 54-060 Ave. Ramirez
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 201
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 2/25/94
APPROXIMATE TIME OF COMPLETION 2/26/94
ESTIMATED CONSTRUCTION COST $ 250.00
(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:
PC --z R,1rJe 2s 1",oZ
Siwl,)DnP_-6 *-)0--,�
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 propee rty
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 ther this work.
a
Signature of Applicant or Agent
Mumbil, Inc P.O.Box 1555, La 0uinta 564-1338
Name of Applicant (please print) Business Address Telephone No.
Bill Howard
Name of Contractor and Job Foreman Business Address Telephone No.
537333
Contractor's License No.
Scotsdale GLS
2526
City Business License No.
499425
Applicant's Insurance Company Policy Number
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 $ .2O
Permit Fee to
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
$ 30—
Date
.I-
FEB 2 4
. 200#
PERMIT VALI Mi
PERMIT NO. CDO? I
DATE APPROVED 2- .24- �µ
EXPIRATION DATE 1 (74
DATE ISSUED 4,q Q y 4
By
AdAnistrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
---------------------------------------------------7--------------
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— _ -Lq — q 4
Subdivision Improvement Permit — Class 111
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
CA
(Street address or. Description of Location)
PURPOSE OF CONSTRUCTIONNIW-k Lsk L AA Aafa M 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 `JL4
APPROXIMATE TIME OF COMPLETION o
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 t rmit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the r I f this work.
S nature of Applicant or Agent
L, -rte s fox isms 001-h&34; � L4-1338'
Name of Applicant (pleas�rint) I Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
x-7333 Sotl�
Contractor's License No. City Business License No.
G-Ls �9g/24
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
Recorded by
$
Date
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564.2246
Administrative Authority
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