2115NOTE.
,A.—Withrproper 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:3/30/94
LOCATION OF CONSTRUCTION 52-995 Ave,.Rubio
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach
DESCRIPTION OF CONSTRUCTION
Same
DIMENSION OF INSTALLATION OR REMOVAL 6X20
SIZE OF EXCAVATION, IF NEEDED
SAME
APPROXIMATE TIME WHEN WORK WILL BEGIN 3130/94
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
APPROXIMATE TIME OF COMPLETION 1 Week
ESTIMATED CONSTRUCTION COST $ 300.00
(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:
Sketch (attach construction plans if appropriate)
Per Riverside County #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.
i
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
Dat*d Ross Miller P.O.Box 722 La Quinta 619-564-0273
Name of Applicant (please print) Business Address Telephone No.
Pacific Trades Deve, SAME
Name of Contractor and Job Foreman Business Address Telephone No.
B425381
Contractor's License No.
1955
City Business License No.
Farmers INs. 0010194
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 $
20.00
Permit Fee
10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
30.00
Receipt No.
Received by
Date
Recorded by
I
MAR r 0 1994
2111v -
PERMIT VALIDATION -
PERMIT NO. 2115
DATE APPROVED 3/30/94
EXPIRATION DATE _8/11/94
DATE ISSUED 3/3Q/94
By
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constmnes an
encroachment permit
CITY OF i -A QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORKS .CONSTRUCTION' (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots. sewer, water mains
and other like public worthsimprovements in. connection with MINOR IMPROVEMENTS And APPROVED SUBDIVISIONS
DATE: Subdivision Improvement Permit — C1ass III
�— Minor Improvement Permit Clan IV
LOCATION OF CONSTRUCTION Z �l S AJ ti; f `f ")
IStraet address or Oescnptron of Loctionl
PURPOSE OF CONSTRUCTION D (C' IJ L A P P 20•_c_t-t
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL -2
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION— I 7-7
ESTIMATED CONSTRUCTION COST S �n • --
(Including removal of all obstruction, materials, and debris, backfilling, cpm.
Wetton and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction plans if app"Mriatal
In consideration of the Wanting of this permit, the applicant hereby agrees to:
Indemnify, defend and Savo the City, its authorised agarrts, officers. rePrasendttws and arnployap, harmless from and
penalties, liabilities or lose restating from pairs or cow aanon and arise My ane MI
happening or occurring a e proxW" resun of n0 out of any aeerdem, lea or darns" to persons or propaity
any wort undartaken under the permit granted oursuant to this application.
Notify the Administrative Authority at lam qty -four 124) hours in advance of the time when wort will be startad.
La Qui with all a Mfora City dit Ordinances, the grrrrs and conditions of the panmrt and all aoplicabb rules and regulations of the CJty of
La Quints and to pay for any additional reWacanrerst necaaary as the result of this wort.
SS
S'lgrtatun of Ppliant or Agent
�•� 'SSS' \l �� 0. Z L . Q. 19
Name of Applicant (please print)
A, \ i ��`S �s Business Address Tetephore No.
Name of Contactor and Job Foreman S� HL.�__ - . S 4 11-k .i
Business Address Telephone No.
�y215-3"6\ �- S
Contractor's License No. Cf
Fovv,t.,`�, qjS -L V0 C City Business License No.
APPlicant's Insurance Company bo d
t 9j
Policy Number
FEES: Subolvislon 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
nspection Fee $
Permit Fee
Penalty
Cash Oeposit-Surety Bond
if required
TOTAL: $
Receipt No.
Received by Data
3ecorded by -------------
PERMIT VALIDATION
PERMICDATE
DATE
EXPIRDATE
By
Administrative,Authority
TELEPHONE: (619) 564.2246
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