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2164N0TE:j 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 DATE: 5-6-94 LOCATION OF CONSTRUCTION 54-700 Obregon Subdivision Improvement Permit— Class III Minor Improvement Permit Class IV (Street address or Description of Location) PURPOSE OF CONSTRUCTION Drive approach Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION per Riverside Co. Std 207 (attached ); DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (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 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. 01 Signature of Applicant or Agent M.L. Construction P.O. Box 228 La Quints CA 92253 564-4447 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman 343335 Contractor's License No. Scottsdale Ins Business Address Telephone No. 2051 City Business License No. GLS 502127 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. Received by $ 20 10 $ 30 Date 2164 PERMIT VALIDATION PERMIT NO. 2164 DATE APPROVED 5-6-94 EXPIRATION DATE 5-13-94 DATE ISS D 5-6-94 By Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 NOTE: With proper validation this form constitutes an encroachment Permit For the construction of public or private curbs, driveways, pavements, sidewalks, parking 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:— _ 941 Subdivision Improvement Permit — Class 111 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION SL/ — 7a Oz ry (Street address or Oeseriptlon of location) PURPOSE OF CONSTRUCTION ARI /<WG %4-0 ?"?e c C. Sketch (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- paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit, the applicant hereby agrees to: I 'do. nov. defend and save the City, its authorized agents, officers, representatives and employees. harmless from and penalties, liabilities or loss resulting from claims or court action and arising out of any aeudant, loss or against any and MI happening or occurring as a proximate result of any work undertaken under the damage p persona or prppeRy Notify the Administrative Authority at least tweet f �� granted pursuant to this aopliotion. ty our 1241 hours in advance of the times when work will be started. Comply with all appliceble City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City Of La Quints and to pay for any additional replacement neommy as the result of this work. M#,elft I"! Z , ,! NamL e of Applicant (please print) �/ , C�n N c 7 -It> i Name of Contractor and Job Foreman AW 33 Contractor's License No. argftsture of Applicant or Agent : 1 1-5 a x Business Address oX Z z5�- Business Address Telephone No. Telephone No. 2 c S_"/ City Business License No. Applicant's Insurance Company SJ2 Policy Number FEES: Subdivision Improvement Permit — Class I11 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 Oeposit•Surety Bond if required TOTAL: Receipt No. ---------------- PERMIT VALIDATION PERMIT NO. DATE APPROVED h EXPIRATION DATE DATE ISSUED T Received by BY � Date ---" Administrative Authority Recorded by TELEPHONE: (619) 564.2246 T" City of La Quinta Public Works Engineering Department Inspector's Daily Log 10 -200 % Commercial/Residential Development 6,1CA , J4,al 74/6'esc % 1, V > Lion Title: ('. mt uu ioa A612 c on Page of C:VMwments and Settings\jrey\My DoamentsVnspector's Log doc R C&4 4 REQUEST FOR INSPECTION OF„ oS 24 HOUR ADVANCE NOTICE �} y DATE - ! PROJECT LOCATION PERMIT NUMBER ' CONTRACTORS NAME PHONE NUMBER !' ' MONDA TUESDAY WEDNESDAY THURSDAY FRIDAY 78-105 CALLE ESTADO • LA QUINTA, CALIFORNIA 92253 • (619) 564-2246 COMPACTION TEST COMPACTION TEST Subgade.................. ❑ Base ........................ ❑ Grading .................... ❑ Curb & Gutter .......... ❑ Drainage .................. ❑ Formwork.................. ❑ Trenches ................ ❑ Striping .................... ❑ Structural Steel ........ ❑ Paving (Asphalt) ...... ❑ Signing .................... ❑ Backfill ...................... ❑ Paving (Concrete) .. ❑ Landscaping ............ ❑ Excavation ................ ❑ Driveway Approach . X !' ' MONDA TUESDAY WEDNESDAY THURSDAY FRIDAY 78-105 CALLE ESTADO • LA QUINTA, CALIFORNIA 92253 • (619) 564-2246