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NOTE t-
' 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. ,
f and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS n+
Subdivision Improvement Permit — Class III
DATE: I / 17 /90 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54' 370 Eiesenhower, La: Quinta' '
(Street addressor Description of Locationl+
Put in a .driveway approach 4
PURPOSE OF CONSTRUCTION Sketch,(attach construction plans if appropriate) -,
• Cut sidewalk• and+ 1 : ( see attached. sketch )'
• DESCRIPTION OF CONSTRUCTION' • . ) I
remove from site.Repour'driveway approach., 2;(13riveway shall:be'constructed
' according to county. standard ,#20`
DIMENSION OF INSTALLATION OR REMOVAL 6 +X22' , •ti #207.) -(SEE ATTACHED)
SIZE OF EXCAVATION, IF NEEDED 4
_ -• . w
:APPROXIMATE TIME WHEN WORK WILL BEGIN immed .
y
APPROXIMATE TIME of COMPLETION ' 3 to 5 a s '
ESTIMATED CONSTRUCTION COST $
(Including` removal of all obstruction, materials, and debris, backfilling, com;
paction indi:placing permanent resurfacing and/or.replacing improvements)
In consideration of the granting of, this permit, the' appl Lcant hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers,'representatives and employees,' harmless from and against any d all, ;•
penalties,aliabilities or'loss resulting from claims or court action and arising out of `any accident; loss or damage to persons or panroperty..'
'.; happening.or^occurring as a proximate result of any work undertaken under ttie permit granted pursuant to,this,application.
«? f Notify the Administrative Authority, at least twenty-four' (24) hours in advance of the.time when work will be started. '_ r
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 resultofthis ,work.', '-
1 . , f •' F.
F _
Signature of Applicant or Agent
- R . • .i- �, Sly r •*...; 4 .. , _ ' - -- * • '. .
C'hnc4fcar T�- fitarr 2d7F._TahRtii't1 WV •lf2 Palm Snri»crc f'F1.9'1322 110 20
k, Name of Applicant (please print), ?'Business Address - " Telephone No., + .,
a �t arr (`.nnct _ ,Tim AvAnPl 1 247 .F"t 'Tahcxni tom' 'WV _ } :K2 Palm Sari naiS (ti].91 �2i-7 n2(1
' 'Name of Contracior;and Job Foreman ' Business Address Telephone No:
f '4R7A3d
` Contractor's License No. r City Business License No.
Cal i f�rni a Tnr3amni t_v r W97nn537 + �`
t` ,'Applicant's Insurance Company "• Policy Number
' FEES: -Subdivision Improvement Permit = Class I I I "' t,
' 00.5 1 s,. io- ,077 O
. Public improvements: 3%of estimated construction costs,•. L i0 GTOTAL f.. ti3E).00'
Private improvements: 3%of estimated construction costs
Minor Improvement'Permit — Class IV: See attached schedule '• • , .`
•,
Inspection Fee $ PERMIT VALIDATION
Permit Fee 'An on
,. > .. PERMIT N0.
Penalty '
;Cash .Deposit -Surety Bond DATE APPROVED 1'/1 7 /4n `
if required t: EXPIRATION DATE • 2'/1.7/90 '
TOTAL: $ •.30''00 1/17/90 Y
DATE ISSUED
'Receipt`No.'
By Received by t Date ° 4 Administrative Authority ~•x
r
•Recorded by '• ^ '' t TELEPHONE: (619) 564`-2246 -'' '
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"lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE:1/17/9C
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
54-370 Eiesenhower, La Quinta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Put in a driveway approach Sketch (attach construction plants if appropriate)
DESCRIPTION sClepcut sidewalk and
1.(see attached sketch)
Irom CONSTRUCTION driveway approach.
2. (driveway shall be constructed
according to county standard #20'
DIMENSION OF INSTALLATION OR REMOVAL 6' XZ2 r e207 .) (SEE ATTACHED)
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION � to 5 Clays
ESTIMATED CONSTRUCTION COST $ 1'ty ' 11U
(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 of Applicant or Agent
",,'ester L. Starr 2.7 .`.rab.cxuit2 V3v. >!#2 Palms Sxar�.nas (6141322--1t72ff
Name of Applicant (please print) Business Address Telephone No.
Gtarr Const. Jim Avc nell 247 ':a„ Tahcfxxit�! Wv, 0 Palm Siorincxs (6191122-1020,
Name of Contractor and Job Foreman Business Address Telephone No.
317a':a4 095
Contractor's License No. City Business License No.
Cali ox��i� �n��ler ri��r I;197037,37
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.
3�1. Cb0
$
Received by Date
PERMIT VALIDATION
PERMIT NO. 5r9
DATEAPPROVED 1/17/9C
EXPIRATION DATE�''�
DATE ISSUED 1/`( a/taa_.
By —
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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