2136�Q01
-At h 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:4/14/94
LOCATION OF CONSTRUCTION 54-510 Alvarado
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 Per Riverside County Standard 1207
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN /15/94
APPROXIMATE TIME OF COMPLETION 4/16/94
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: �.
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.
4
Signature of Applicant or Agent
Raymond Hubbell 65-791 10th Street, Desert Sot Springs 9 '0687
Name of Applicant (please print) Business Address Telephone No.
SAME
Name of Contractor and Job Foreman Business Address Telephone No.
663009 120
Contractor's License No. City Business License No.
Accord golden eagle INS.
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 20.00
10.00
$ 30.00
Received by Date
PERMIT VALIDATION
PERMIT NO. 2136
DATE APPROVED '� � !7T
EXPIRATION DATE `'Y — ��
DATE ISSUED, 41 lq—
By
Recorded by 11 TELEPHONE: (619) 564-2246
inistrative Authority
eJ
:�'..
A. aalhi.
NOTE:
With proper validation
this form constitutes an
encroachment Permit CITY OF LA QUINTA
APPLICATION FOR PERMIT
'-PUBLIC WORKS CONSTRUCTION • (ENCROACHMENT)
For the construction of public or private curbs, driveways, paven.Mm. sidewalks, parking lou, sewers, water raise
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
1, .
DATE:
LOCATION OF CONSTRUCTION SV
Subdivision Improvement permit — Class ill
Minor Improvement Permit Class IV
(Scram addna or Oasawtion of Locetlonj �.
PURPOSE OF CONSTRUCTION t111�iU_I< W AY 1
�---� ��( Sctch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
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
paetion and placing permanent resurfacing and/or replacing improvements)
C��-c�cr
In consideration of the granting of this permit, the applicant hereby agrees to:
Indermnotes, l defend and save tit. city, its authori:ad agents, offieara. representativa and employee, harmless from and •gaunt anti and all
haMenin liabilities n lost r"ulting from chums Or court action and arising out of any sccxb t, los W
happenmrq w oavmrmq a a proximate result of any wort urhdertaken under the permit to parsons O► prppNty
Notify the Administratmva Authority at leant twin f granted pursuant to this appliptmon,
ty our 124) hours in advance of the time when wort aril be started
O�pW with all applicebla City Ordinenoh. the terms and Conditions of the pwmmt and all applicable rules and rsgillUL ne of tlhe f.;1ty of
V Guints and to pay for any additional "Sca wnt necessary u the result of this wort.
Nance of Applicant (please
A AAS
Name of Contractor and Job Foreman
�ol�3C)d q
Contractor's License No.
Applicant's Insurance
Signature of Applicant or Agent
/ 7 ('
(!2 &_&D o
Business Address
Business Address
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 S �d
Permit Fee I
?enalty
ash Deposit -Surety Bond
.f required
TOTAL:
Receipt No.
deceived byNecorded by
Date
1
Telephone f4&
3.2q ( 1, -0
Telephone No.
City Business License No.
Policy Number
x •�
PERMIT VALIDATION
PERMIT NO.
DATE APPR ED
EXPIRAT N DATE
DATE LIED
Administntive Authority
TELEPHONE: (619) 5642246
arr*