2172r, _
N.erE:
W th 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: 5-13-94
LOCATION OF CONSTRUCTION 51-260 Velasco
(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 5-1.4-94
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Per Riverside County Std. No 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 conditi • ns of theper it and all applicable rules and egulations of the City of
La Quinta and to pay for any additional replacement necessary as th esult of h s o, `�
Signature of A plicant or Agent
Pacific Trades Dev. P.O. Box 722 La Quinta Ca 92253 564-0273
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
B425381
Contractor's License No.
Farmers
Applicant's Insurance Company
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
10
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
30
TOTAL: $
Receipt No.
Received by Date
Recorded by
1955
City Business License No.
4079794
Policy Number
J
MAY 13 1
2 1 7 2*V -----
PERMIT VALIDATION
PERMIT NO. 2172
DATE APPROVED 5-13-94
II4
EXPIRATION DATE 5-20-94
DATE ISS ED 5-13-94
By
Administrative Authority
TELEPHONE: (619) 564-2246
,1
K
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 lou, sewers, water ruins
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
r•
DATE: -13 Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION - " 2 �. A Ly �_'- N 5 L0
(Street address or Oescnptlon of Location)
PURPOSE OF CONSTRUCTION
Sketch (attach cons—
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 5t
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION f l 1
ESTIMATED CONSTRUCTION COSTS
(Including removal of all obstruction, materials, and debris, backfilling, com.
paction and placing permanent resurfacing and/or replatang improvements)
ctlon plans jr approprgq)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and saw 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
happening or occurring as a proximate insult of any work undertaken under the darh to persons Or prppNty
a.rmrt granted pursuant to this applicetion.
Notify the Administrative Authority at least twenty-four 124) hours in advance of the time when work will be started,
Comply with all appliceble City Ordinances, the tarns and conditions o the pe it nd all applicable rules and regulations of the GH of
La Quints and to pay for any additionsi replacement nere::ary as the t of is
n
k_zN
Name of Applicant (please print)
A4-QAVk C. 'k -,CL,, (N°
Name of Contractor and Job Foreman
'&A Z S3 (R-1
Contractor's License No.
�_42 *-\ �_25 llt
Signature of A
�. 0 . tx
Business Address
or Agent
Telephone No.
Business Address Telephone No.
City Business License No.
Applicant's Insurance Company V I 1 1
Policy Number
FEES: Subdivision Improvement Permit — Class I11
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permits—Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$-3
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2248
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