2210,NOTE:
With prodttitutes
lidation
this form 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
I
DATE: 6-27-94
LOCATION OF CONSTRUCTION 52-140 Montezuma
(Street address or Description of Location)
. PURPOSE OF CONSTRUCTION Driveway approach
DESCRIPTION OF CONSTRUCTION Concrete Construction
DIMENSION OF INSTALLATION OR REMOVAL 5} 1x22'
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6-27-94
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
APPROXIMATE TIME OF COMPLETION 6-28--94
ESTIMATED CONSTRUCTION COST $ 400.00
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacng improvements)
In consideration of the granting of this permit, the applicant hereby agrees
Sketch (attach construction plans if appropriate)
SBE ATTACHED STD #207
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.
Signature of Applicant or Agent
DESIGN WEST CONCRETE `
Name of Applicant (please print) Business Address Telephone No.
R.V. HARREL
Name of Contractor and Job Foreman Business Address Telephone No.
610083 2018
Contractor's License No. City Business License No.
GARCIA INS., PALM SPRINGS, CA 92262. BCP 222662201
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 $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
2210
PERMIT VALIDATION
PERMIT NO. 2210
DATE APPROVED 6-27-94
EXPIRATION DATE 7"1-94
DATE ISS ED 6-27-94
By I
! Administrative Authority
TELEPHONE: (619) 564-2246
I
NOTE:
With proper validation
this form constitutes an
encroachment cermn 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 main$
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE:6--33 9
LOCATION OF CONSTRUCTION �a 1
Subdivision Improvement Permit — Class 111
Minor Improvement Permit Class %V
(Sweet &Wren or Oesaiption of Location)
PURPOSE OF CONSTRUCTION
j Y1' Sketch (attach construction plans if appropriap)
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 COSTS �Q
(Including removal of all obstruction, materials, and debris, backfilling, com.
Paetion and placing permanent resurfacing and/or replacing improvements)
SQ -.Q -acs �u\e� .
In consideration of the granting of this permit, the applicant hereby agrees to:
1 4erhnify, defend and Sava the City. 'IS authorized agents, officm. representatives and empioyeas, harmless from and
Penalties. liabilities or ions rmiting from chutta or court action and arising Out of any aeudant, loss l against any • ail all
Aaopen�ng or occurring as a Proximate result of any work undertaken undar the Permit granted Pursuant to r�atpplicettiion o► prnpeity
Notify the Admimstratrva Authority at least tvvanty.fpur (24) hours in advance of the time when work will be started,
COMWy $nth all aoolieable City Ordinances, the terms and aconditions of the permit and all applicable rules and regulatbns of the Gly Of
V Quints and to pay for any dditional replaantent neoeeesry as the result of this work.
r
Name of Applicant (please print)
Signature of Applicant or Agent
Business Address
Telephone No.
Name tit Contractor and Job Foreman
Business Addressl� Telephone No.
C tractor's License No.
Applicant's Insurance Company
Policy Number
FEES: Suboivision 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 �, V
Penalty
Cash Deposit -Surety Bond
if required
TOTAL.
$ 12b
Receipt No.
Received by Date
PERMIT VALIDATION
PERMIT NO.y Z�
DATE APPROVED 21
EXPIRATION DATE
DATE ISSUED
By
Ad
r
mi
!recorded by nlstratrve Authority
TELEPHONE: (619) 564-2246
7
Siote of Colifornio
9&:
Corsumer y CONTRACTORS STATE LICENSE BOARD
Allain ACTIVE LICENSE (a :
License Numbei b 1 0 0 8 3 E,,iy IND IV
Bus next Name DESIGN WEST CONCRETE
I classiimalia*l C-8 B
Expiration Date
01/31/95,
lu