2131l
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:4/12/94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-420 Ave. Alvarado
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION (!nln,gtruct A' MAIN Rlnnle WA11
'tI nn C4ty Drnr.rty
DESCRIPTION OF CONSTRUCTION A' tH49h 111nnh WA11
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 4/12/94
Sketch (attach construction plans if appropriate)
There shall be a ainimum of 10'
of clearance between curb and the
block wall.
o,q o
APPROXIMATE TIME OF COMPLETION 4/16/94r� AP 2 1994
ESTIMATED CONSTRUCTION COST $
1
(Including removal of all obstruction, materials, and debris, backfilling, com- r By
paction and placing permanent resurfacing and/or replac.ng improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
_y
Indemnify, defend and save the City, its authorized agents, le officers, representatives and employees, harmless frort9 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
Elenor Shiva 54-420 Alvarado
Name of Applicant (please print) Business Address Telephone No.
Tom Stone Masonry P.O.Box 1333 La Quinta 564-2128
Name of Contractor and Job Foreman Business Address Telephone No.
494257 C-29
Contractor's License No.
1228
City Business License No.
ON File
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
20$00
10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
2131
PERMIT VALIDATION
PERMIT NO. 2131
DATE APPROVED
4/12/94
EXPIRATION DATE 4/22/94
DATE ISSUE) 4/12 4
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
4
NOTE:
With proper validation
this form constitutes an
encroachment permit CITY OF LA. _QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION ANCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water stains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
..
DATE: - _ Z . ' �' �_ Subdivision Improvement Permit — Class 111
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION C` �I — �1 7 L V e �n
(Street address or Oasarpt,on of Location)
:IIS I I.
PURPOSE OFF ONSTRUCTION
12/a. / In r — _ i
DESCRI TI?p OF CONSTRUCTION
rK c 4- Sketch (attach construction plans if appropriate)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction, materials, and debris, backfilling, com.
Pwtion and placing permanent resurfacing and/or replacing improvements)
'F-D�( VIE& C14 Cf~ P'--(3 ^-I I>
In consideration of the granting of this permit, the applicant hereby agrees to:
Intlernnrfy, defend and save the City, its audtori:ed +gents, officers. repr"MUtim and arnployeg, htrtnlase front and against any and MI
penalties, liabilities or loci resulting front claims or court action and arising out of any accident. toss or
hoccurringa0"nrng or occurring a a proxii 0asu
te rtt of any wort undertaken under the permit granted Ou 00 of to me ato pgr q s or y
Notify the Administrative Authority at least twertN•four 1241 hours in advsnee of the time when wort snll be started,
Comply with all appliesble City Ordina C". the tenors and conditions of the 0antt and all
V Quina and to Day for WWadditional replaeennnt sensory as Me ntsult Of m sOAlieabl las and rs'gltlatww of the City Of
Signature of Applicant or Agent
S �L(/2.¢vQ G.G.
Name of Applicant (please print)
...- cr V1 i.7 Nic
Name of Contractor and Job Foreman
Li q Lf a-- S-7 C - Contractor's License No.
Vr�
Business Address Telephone Na
013 0 se, /a�-3 4o .f~( G! —94Z, _
Business Address Telephone Na
"�TQ�
xA V
Q Clty Business License No.
APplicant,s Insurance Company
Policy Number
FEES: Subolvlsion 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
3ermit Fee / 0
'enalty
:ash Deposit -Surety Bond
f reQuired
TOTAL:"
leceipt No.
'ecelved by Date
acorded by -"
PERMIT VALIDATION
PERMIT NO. - i' 2 1.5 1
DATE APPRQ'�/ED
EXPIRAT /N DATE y-
DATE.1 UI
Administrative Authority
TELEPHONE: (619) 564-2246