2127III
v
With proper validation �/�� P
this for 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
4/8/94 Subdivision Improvement Permit— Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53255 Avenida Herrera
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Dtiwwan Anrroach:
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 4/11/94
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 4118/94
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) _
I In consideration of the granting of this permit, the applicant hereby agrees to:
Per Riverside County Standard $207
(Attached)
:. p aQ
In 1994
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work. l�
SigCature f Applican or Agent
John W. Bull 52255 Ave:. Herrera La Ouinta (619) 564-2988
Name of.Applicant (please print) Business Address Telephone No.
OWNER/BUILDER
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee 20.00$
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by
Date
2127
PERMIT VALIDATION
PERMIT NO. 2127 Q C�
DATE APPROVED Ljl8- /Q
—1%09%. -
EXPIRATION DATE
DATE ISSUED j, 10 7 ACS -
By
Recorded by 11 TELEPHONE: (619) 564-2246
nistrative Authority
1
TW
NOTE:
Witirproper validation
this form constitutes an
encroachment cermn
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
CITY OF LA _ QUINTA--
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
..
DATE: �/?/?
LOCATION OF CONSTRUCTION S3asS
(Street address or 0"CritniOn of Locetion)
,% w
Subdivision Improvement Permit _ Class 111
1 or Improvement Permit Class IV
VeN10A 71 xzre2,-oJ
PURPOSE OF CONSTRUCTION C011s Ne-+ Ung arc�j
a
DESCRIPTION OF CONSTRUCTION — r, -w L -V C-1fb
b Gl?Alr' d.� a�w � v
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION_ _ — ZEE=
ESTIMATED CONSTRUCTION COSTS ' '
(Including removal of all obstruction, materials, and debris, backfilling, com.
Paetion and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction plans if appropriMl
R-rverI C� CVh�
:t�- 207
In consideration of the granting of this permit, the applicant hereby agrees to:
Indernnlfy. defend and saw the City. Its authorized a"rtes, officers, reoreserttaciva and amoloyae>s, harrrtlass front art0
penattln. I�abilitia or Ion rMiting front claims or court att,on incl OVI&risOut Of a against eM end all
haopemng or OOCu_ng a a prox"nM mutt of a any ��nt. loss or dame" to penoni or propeity
M wort undertaken under the permit granted pursuant to this applicatlon.
Notify the AdmimstratM Authority at least twenty-four 124) hours in advance of the time when wort Neil be started.
Comoly with all applicable City Ordinances, the terms and conditions Of the permit and all applicable ruin and n4i40iore Of the C1ty at
La Quints and to pay for any additlonat nptaeenterit necnwV as the result Of this wort.
ke\ W. &—it
Name of Applicant (please print)
(0vf \a.1 / %Jr I
Name of Contractor
Job Foreman
Contractor's License No.'
5t0na a of A ±,cant or Agent
IT AVfA I dr- PW Q 2
Business Address Telephone No.
Business Address Telephone No.
City Business License No.
Applicant's Insurance Company
Polity Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated constriction costs
Minor Improvement Permit — Class IV: See attached schedule
inspection Fee $ 2
D
Permit Fee 10
3enalty
:ash Deposit -Surety Bond
f required
TOTAL:
130
---------------
-qemipt No.
3eceived by Date
3ecorded by
PERMIT VALIDATION
PERMIT NO. /2 Zrl
S
DATE APP�dVED yr $ - R y
EXPIRA ON DATE
DATE UED
By t ��
Administrative Authority
TELEPHONE: (619) 564-2246
t
t
I'
f.
v �
REQUEST FOR INSPECTION
-4�
OF 24 HOUR ADVANCE NOTICE
a�
DATE
PROJECT LOCATIONPERMIT NUMBER
2 ss �1
�•e e1a4 D/ 0 --?
T^ CONTRACTORS NAME PHONE NUMBER
�Ic stir 3F. t -L 5l/b �z— ;� 988
COMPACTION TEST COMPACTION TEST
Subgade.................. 0 Base ........................ ❑ Grading .................... 0
Curb & Gutter .......... ❑ Drainage .................. 0 Formwork.................. ❑
Trenches ................ ❑ Striping .................... 0 Structural Steel ........ ❑
Paving (Asphalt) ...... ❑ Signing .................... 0 Backfill ...................... 0
Paving (Concrete) .. ❑ Landscaping ............ 0 Excavation ................ ❑
Driveway Approach . JOS_.
wo
-1.2h�s/
MONDAY QUESDAY )WEDNESDAY THURSDAY FRIDAY
78-105 CALLE EST AD'O OUINTA, CALIFORNIA 92253 • (619) 564-2246