21654
-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, 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 II I
DATE: 5-6-94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-870 Montezuma
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
Per Riverside Co. Std 207
(attached)
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 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�tw work.
Signature of.AppUcant or ent
DoDco Const. P.O. 'Box 1012 La Quinr A 92253
Name of Applicant (please print) Business Address Telephone No.
Dan Featheringill
Name of Contractor and Job Foreman Business Address Telephone No.
397830 1375
Contractor's License No. City Business License No.
Golden Eagle CCp178797
Applicant's Insurance Company Policy Number-
! /Z\ n
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 20
10
$ 30
Date
MAYO 6 1994
PERMIT VALIDATION
PERMIT NO. 2165
DATE APPROVED 5-6-94
EXPIRATION DATE
5-13-94
DATE I S ED 5-6-94
By -
Administrative Authority
TELEPHONE: (619) 564-2246
rA
NOTE:
With proper validation
this form constitutes an
encroachment oermit 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 maims
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE y (,V— ( CY
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
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 th
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
1
Sketch (attach construction plans if appropriate)
e applicant hereby agrees to:
Ida, mfydefend and saw the City, its authorised agents.
penenalties, liabilities or loss resulting from claims Or cOUR officers. represenntives and employees. harmless from and against any and all
laction and wising Out Of any accident. loss Or to persons or
happening or Occurring as a proximate result of any work undertaken under the permit granted pursuant to tl�t
appI ion. Y
Notify the Administrative Authority at leant twenty-four (2`I hours in advance of the time when work will be started.
COm01Y with all applicable City Ordinances, the terms and conditions of the permit and all applkaWa rules and regulat ons of tAis City Of
La Quints and to pay for any additional reptacerremi necessary as the of th'
i
Signature of Applicant or ,k4 nt
Name of Applicant (please print)
Name of Contractor and Jo oreman
\/-, 39 ?YSC)
Contractor's License No.
7
Applicant's In
Business Address
2:��
Business Address
Telephone No.
Telephone No.
k /.3?: -
City Business License No.
0
Policy Number
FEES: Subolvision 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
�I
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
I
Receipt No.
Received by Date
Recorded by
T
PERMIT VALIDATION
PERMIT NO
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
,
4