2318NOPE:
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 lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: 3-8-95
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
51-860 Eisenhower
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Replace broken sidewalk
DESCRIPTION OF CONSTRUCTION R R sidewalk, compact Corm
and place concrete
DIMENSION OF INSTALLATION OR REMOVALApprox' 5.5.x
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN —9-9
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 3-13-95
ESTIMATED CONSTRUCTION COST $ 100
(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:
Install sidewalk per Riverside Co.
Standard #401
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.
Tri- State Const.
Name of Applicant (please print)
„%Signa"ture of Applicant or Agent
P.O. Box 542 Cathedral City, CA 321-0898
Business Address
Telephone No.
Larry Owens
Name of Contractor and Job Foreman Business Address Telephone No.
475515 7623
Contractor's License No. City Business License No.
Farmers Ins.
Applicant's Insurance Company Policy Number
10
FEES: Subdivision Improvement Permit — Class I I I MAR 0 8 1995
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs BY
Minor Improvement Permit — Class IV: See attached schedule 2318 IV
A�
Inspection Fee $ 20 PERMIT VALIDATION
Permit Fee 10 2318
PERMIT N0.
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
$ 30
Received by Date
DATE APPROVED 3-8-95
EXPIRATION DATE 3-20-95
DATE ISS 8-95
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
-:1, ".,
M
X
NOTE:
With proper validation
this form constitutes an 8
encroachment permit CITY OF LA QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
C�
For the construction of public or .private curbs, driveways, pavements, sidewalks, parking lou, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: ) Subdivision Improvement Permit — Class III
Min Improvement Improvement Permit Class IV
LOCATION OF CONSTRUCTION �^ �' •G �i fc'�hC"u/ e��
(Street address or Oerciption of Location) 9 /
PURPOSE OF CONSTRUCTION/fieI(Cetdt (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN S
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and pfacnq 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, representativearty nd amploVea. harmless from and sp utin ait" end all
Penalties' liabilities or lea resulting from dsims or court action and arising out of aaccident. lea or damopa to persons or prop@;"
naopenirq or oocurrirq as a proximate remit of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twent"•four 1241 hours in advance of the time. when work will be start@&
Comply with an & Wicebfe City Ordinances, the terms and conditions of the permit end dl applkebte rota end regulations @f cite City of
La Quints and to pay for arty additional repiacernent necaasry a the result oaf this work.,
/ �e¢naCure of pplicaM or A{pnt
r _ s s7~ o Q0� S�,l z �Z / 08909
Name of Applicant (please orintl
Name
of Contr6ctor and Job Foreman
X 7�J 1!�_
Contractor's License No.
24
Applicant's Insurance Company OICU. LIABILITY Policy Number
FEES: Subolvision 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 S 2-4
Permit Fee % V
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
a 3b
Received by Date
Recorded by
1386
• PERMIT VALIDATION
PERMIT NO. -3 18-
13, 8 6 8
DATE APPROVED 3^e t
EXPIRATION DATE 3 . ZD
DATE ISSUED
By /
Administrative Authority
TELEPHONE: (619)77s