425NOTE:
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
7/26/89
LOCATION OF CONSTRUCTION
77--811 Calle Sinaloa
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Concrete Driveway
DESCRIPTION OF CONSTRUCTION Place concrete D/W
from property line to edge of pavement.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 7/2889
Subdivision Improvement Permit —Class II I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Driveway shall be constructed
per Riverside Co. Stds.
Permitet shall notify City 24 hrs
pr&or to the start of work.
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:
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 oVApplican or Agent V
Robert R. Jaeckens, Sr. 77-811 Cal1e Sinaloa 568-4800
Name of Applicant (please print) Business Address Telephone No.
same dame same
Name of Contractor and Job Foreman Business Address Telephone No.
CIO 502256
Contractor's License No.
City Business License No.
Kemper UP 425609
Applicant's Insurance Company Policy Number _.
FEES: Subdivision Improvement Permit —Class III 00-iS2 0 PORT 07-26-89 1('
10 CA- H 1 TU7AL i io oo
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
y
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ N/A
10.00
$ 10.00
Received by Date
PERMIT NO.
N e, 425
PERMIT VALIDATION
425
DATE APPROVED 7/26/89
EXPIRATION DATE 8/31/89
DATE ISSUED 7//2.66//8899
By
Administrative Authority
Recorded by' II TELEPHONE: (619) 564-2246
NOTE:
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 II
DATE: 7- r�� /� I Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION - " g OA U,F, S I N a lQ t--+
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 6CME ► �Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION SD/� sA Ll
/4i''
DIMENSION OF INSTALLATION OR REMOVAL f�
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE'TIME WHEN WORK WILL BEGIN
'Z�
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, badtfilling, com-
paction and placing 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, 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 124) 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
Name of Applicant (please print) Business Address Telephone No.
RoBF,eT R . i ��� KF j,1S m F Sit.G
Name of Contractor and Job Foreman Business Address Telephone No.
C� I ® Co a���
Contractor's Lficense 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
v
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED' : T4
EXPIRATION DATE=7�3—�'�
DATE ISSUED ze�a ZAIg
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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