2196NOTE:
With pj;�oer validation
this foam 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: 6'"1"94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
54-340 Caranza
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6-1-94
APPROXIMATE TIME OF COMPLETION 6-2-94
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:
PER RIVERSIDE COUNTY STD 207
ATTACHED
JuN o 1 Pf
,,
g� I 1 1994
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless froand against any ,and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or dama a to persons or property
rsuant
happening or occurring as a proximate result of any work undertaken under the permit granted puto thi 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 permits I applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of #Sis 6r .
�9
Signatu a of Applicant or Agent
THOMAS TOLES 48-100 BEVERLY, PALM DESERT, CA 92260 346-7767
Name of Applicant (please print) Business Address Telephone',No.
OWNER BUILDER
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
F4ZM F25 419912 3577.0
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 00.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
$ 30.00
Received by Date
2198
PERMIT VALIDATION
PERMIT NO. 2196
DATE APPROVED
EXPIRATION DATE
6-1-94
6-15-94
DATE ISS ED 6— 94
By
Administrative Authority
Recorded by J1 TELEPHONE: (619) 564-2246
V_ lop
NOTE:
With proper validation
this form constitutes an
encroachment oermn CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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
DATE: L
YLOCATION OF CONSTRUCTION
Subdivision Improvement Permit - Class III
Minor Improvement Permit Class IV
(Street address or Oaseriptlon of Loeapon
PURPOSE OF CONSTRUCTIONA`1 f�✓l�xfit
Sketch (attach construct
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
ROXIMATE TIME WHEN WORK WILL BEGIN i�Z- I -
APPROXIMATE TIME OF COMPLETION -
ESTIMATED CONSTRUCTION COSTS
(Including removal of all obstruction, materiais, and debris, backfilling, com.
Paction and placing permanent resurfacing and/or replacing improvements)
on plans if approprilm)
-7 STT✓-�-��-�
In consideration of the granting of this permit, the applicant hereby agrees to:
Indermmfy, defend and save mi City. Its authorized agents, officers' reProssntstivi and amOloyees, harming from and
penaltln, "abilities or lots resulting front clams or court action and arising out of any accident, loss ori any arld MI
happening or occurring as a Drosinvte r*sult of any work undertaken under the damage to persona or proOeRy
Permit granted pursuant to this application.
Notify the Admimnrl tive. Authority at least twenty-four (241 hours ,n advance of th�,"Iw
ti
rk will be started.
Comply with all applicable City Ordinances, the terms and Conditions of the permr La Quints and to pay for any additionalrepleeerrlent n ruin and rogu�th0 CJty of
necessary as the result of this
Name of Applicant (please pr
Name of Contractor and Job Foreman
Contractor's License No.
— � L
Slonstyfe of pplicant or A nt
Business Address Telephone No.
Business Address Telephone No.
City Business License No.
Applicant's Insurance Company
Policy Number
FEES: Subdivision 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 $ n
Permit Fee
Penalty
Cash Oeposit•Surety Bond
if required
TOTAL:
Receipt No. .
$
Received by Date
3ecorded by
YT
PERMIT VALIDATION
PERMIT NO. y
DATE APPROVED IL
EXPIRATION DATE (P -Ii /
DATE ISSUED - to
By
Administrative Authority
TELEPHONE: (619) 564.2246