2182I. C>
NOTi::
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: 5-23-94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-600 Montezuma
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Driveway Approach Per Riverside Co. Std No. 207
(attached)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ti -1-94
APPROXIMATE TIME OF COMPLETION 6-7-94
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:
;I MAY 23 1994 iJl
BY
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
Signature of Applicant or Agent
_John M Ivancich 73-379 Country C1u'6 Dr. 3502 Palm Desert, CA 92260 773-0967
Name of Applicant (please print) Business Address Telephone No.
Curb Saving Inc. 321-9700
Name of Contractor and Job Foreman Business Address Telephone No.
589084
Contractor's License No.
Safeco
2095
City Business License No.
80154620
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 20
10
$ 30
Received by Date
PERMIT NO.
2182
PERMIT VALIDATION
2182
DATE APPROVED 5-23-94
EXPIRATION DATE
DATIfISSPED 23"94 _
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an
encroachment permit CITY OF LA QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
nor 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• 2 3 Subdivision Improvement Permit — Class 111
Minor Improvement Permit Class IV
X LOCATION OF CONSTRUCTION _�J — lvD L L 0 W 7' (Street address or Description of Location)
PURPOSE OF CONSTRUCTION
OEe IPTION OF CONSTRUCT ON v
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
ROXI �E TIME WHE� WORK)NILL BEGIN
(1) \J0luC
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)
Sketch (attach construction plans if appropriate)
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 seeidartt, loss or
damage happening or occurring as e proximate rewit of any work undertaken under the permit granted pursuant to this ap Oersont or propa'ty
Notify the Administrative Authority at least twee t plicetgn.
ty. our (24) hours in advance of the time when work will be started.
Comply with 811 applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of dee Citof
La Quints and to pay for any additional M018cemertt necessary as the result of this work. y
J,��, �,A_ I,
of Applicant (please print)
Name of Contractor and Job Foreman
Contractor's License No.
F(_0
Signature of Applicant or Agent S o —L-
-3-73 (�AvwT-" GuON, D(Z 773'6g67
Business Address
Telephone No.
.% w I w w, 3 2! �l 7 Od
Business Address Telephone No.
2c
City Business License No.
X � /-) I T_— 4—
Applicant's Insurance Company � Z
� Polity Number
FEES: Subalvislon Improvement Permit — Class II I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 2
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 3n
Received by Oeste
Recorded by
,T
PERMIT VALIDATION
PERMIT NO
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
C