2236NOTE~
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
DATE: Z 9-19-94
LOCATION OF CONSTRUCTION _
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
52-740 Carranza
construct sidewalk
DESCRIPTION OF CONSTRUCTION construct 6-XT0_
sidewalk next to curb
DIMENSION OF INSTALLATION OR REMOVAL 640 concrete
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 9'19-94
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
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:
Sketch (attach construction plans if appropriate)
r.
SEP ,
9 1994
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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 th" rm.t and all applicable rul -a d regulations of the City of
La Quinta and to pay for any additional replacement necessary as the re ult of thi ork.
1
Signatu v of plicant or Agent
Greg Donnelly 52-740 Carranza 340-9699
Name of Applicant (please print) Business Address Telephone No.
ownwer builder
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
Farmers
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I 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.
Permit Fee 10
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30
Receipt No.
Received by Date
Recorded by
PERMIT NO
2236
PERMIT VALIDATION
2236
DATE APPROVED 9-19-94
EXPIRATION DATE
9-29-94
DATE IS ED 9-19-94
By
Administrative Authority
TELEPHONE: (619) 564-2246
3
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
water rmins
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED
..
DATE: 9 g
LOCATION OF CONSTRUCTION —5
(Street sodrass or Dastription of Location)
PURPOSE OF CONSTRUCTION iM Pe011�T
0E1PAPTj9ft0F,CONST RUCTION
EMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class 111
91— Minor Improvement Permit Clan IV
Sketch (attach construction plans if app"Mrim)
APPROXIMATE TIME OF COMPLETION 'tr—
ESTIMATED CONSTRUCTION COSTS
(Including removal of all obstruction, materials, and debris, backfilling, cont.
psetion and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
lrx
Penalties. liabilities defend and saw the City, its author':ed agents. officers. representative• and emploveea, harmless from end against any end all
harp nin cuor los resorting from aa�ms or court action and arising out of any student, los or
happening or occurring as •oro:'mate result of any work urid•rnken under the damage to persons or prOpMty
Notify the Administratrw Authority at m'e"n toren f permit granted pursuant to this application.
ty our (24) hours in advance of the torte when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the rt • 11 atiplieable rules e
La Quints and to pay for any •dditione, reol&cwrwm n ions of the cuy at
eceaery as the t� f this
A A m/
V
52 7 y0 Si tur f A I' nt or Agent
uv7 �
Name of Applicant (please print)
1 Od(� Business Address Telephone No.
Name of Contractor nd Job Foreman
I
!i Contractors License No.
Business Address Telephone No.
City Business License No.
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. .
received by Date
recorded by
PERMIT VALIDATION
PERMIT NO. -Z Z 3 61
DATE APPROVED 7— / t4/
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
T
Administrative Authority
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