2083NOTI f
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
Subdivision -Improvement Permit — Class I11
DATE: 2/25/94 y Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-725 Ramirez
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 201
SIZE OF EXCAVATION, IF NEEDED `
APPROXIMATE TIME WHEN WORK WILL BEGIN 21/25/94
Per Riverside County Standard #207
D q �
EB 2 8 1994
By L
APPROXIMATE TIME OF COMPLETION --
ESTIMATED CONSTRUCTION COST $ 200.00
(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.
Signature of Applicant or Agent
Starlight Management Inc. P.O.Box 804. La Ouinta 399-1200
Name of Applicant (please print) Business Address Telephone No.
Willift Rogers
Name of Contractor and Job Foreman Business Address Telephone No.
291728 /964
Contractor's License No. City Business License No.
�.4A1 1, ft /(A 'rFlj IJ.its .1.o•._
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class II I
Public improvements:3i3% 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.
$ r�)() I-
1 1
—
.1 O
Received by Date
Recorded by
2083
PERMIT VALIDATION
PERMIT NO. 120133. f ''II
DATE APPROVED A� �a / �! `t'
EXPIRATION DATE 3�/ �T•
DATE ISSUED41 A kZ a'4^—
a c
By
Administrative Authority
TELEPHONE: (619) 564-2246
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
Subdivision Improvement Permit — Class I I I
DATE: °�S Minor Improvement Permit Class IV
LOCATION OFC NSTRUCTION,7`
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION 1e�
DIMENSION OF INSTALLATION OR REMOVAL -0
SIZE OF EXCAVATION, IF NEEDED le
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ Zed
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction plans if appropriate)
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.
Signature of Applicant or Agent
/ylarf/ CIV,6 fZ_ -� � .Wg -
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address 'Telephone No..
,.e
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