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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
7-3-91 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
-LOCATION, OF CONSTRUCTION — 51-145 g4ito
(Street address or Description of Location)
PURPOSE•'OF CONSTRUCTION driveway annroaeh Sketch (attach construction plans if appropriate)
• .DESCRIPTION OF CONSTRUCTION asphalt install asphalt from driveway
to edge of pavement.
DIMENSION OF INSTALLATION OR REMOVAL t
`SIZE OF EXCAVATION, IF NEEDED
{.APPROXIMATE TIME WHEN WORK WILL BEGIN'
APPROXIMATE TIME OF COMPLETION
. ,ESTIMATED. CONSTRUCTION COST $
(Including removal of all obstruction,material s, and debris,-backfilling,.com
;paction and- placing zpermanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
J
In demnify,•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.'.
Complyy 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
ALLEN GRADING AND PAVING .72-880 sonora PALM DEBERT CA 346=6361 {
Name of Applicant (please print) Business Address Tele phone No. „�..
PETE ALLEN
Name of Contractor and Job Foreman Business Address Telephone No.
$ = 417180 1590
.Contractor's License No. City Business License No.
STATE FARM' 811 5893`,' f05 55a ,� _ . �—
0AS81 40 14
Applicant's' Insurance Company Poli -Nu Efl, i -TOTAL 1 30 11,00
FEES: . Subdivision Improvement Permit —Class III C!�hLi�O
Publ'ic.improvements: 3%0 of estimated construction costs113
A
Private improvements: 3% of estimated construction costs t `'
Minor. improvement Permit - Class, IV: See attached schedule `
`Inspection Fee $ PERMIT VALIDATION
10.00 /139
Permit Fee PERMIT NO.
'Penalty 7-3- C
'. Cash Deposit -Surety Bond DATE APPROVED
if:.,required � r:RAT ION A E 30.00. TOTAL: $ —q
Receipt No.
Received by Date
Recorded by
By
Administrative Authority .
TELEPHONE: (619) 564-2246
,a•a
- - � ,F - .. ... ..�„ �,.'� ... .` rMw v ...r r•- .... r '.��.:•..��..e.�—=+r '1'' .S— �n, , r?;: r'4:� �}•'•� .{'r",�
f'"'�
ff
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 .
7-3-91 Subdivision Improvement Permit — Class II I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 51-145 quito
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION driveway approach Sketch (attach construction plans if appropriate).
DESCRIPTION OF CONSTRUCTION asphalt install asphalt from driveway
to edge of .pavement
DIMENSION OF INSTALLATION OR REMOVAL
i
SIZE OF. EXCAVATION, IF NEEDED
1
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, corn
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
ALLEN GRADING AND PAVING 72-880 Sonora PALM DENERT CA 346-6361
Name of Applicant (please print) Business Address Telephone No.
PETE ALLEN.
Name of Contractor and Job Foreman . Business Address Telephone No.
$ 417180 1590=
Contractor's License No. City Business License No.
M STATE FARM 811 5893 f05.55a
IZA oCj A-7-0'%-94 44.
Applicant's Insurance Company Pomo Nu SVi 7A S 30.00
.'.FEES: Subdivision Improvement Permit — Class 111 i•/%, - �'y(; �`
Public improvements: 3% of estimated construction costs �j 3!J .
Private improvements: 3% of estimated coristruction costs f
Minor Improvement Permit — Class IV: See attached schedule .
Inspection Fee $ 20.00 I PERMIT VALIDATION 1
10.00
Permit Fee
Penalty
Cash .Deposit -Surety Bond
i,f,re q u i red
TOTAL: $ 30.00
PERMIT NO. r
DATE APPROVED '7`3— c'%l
E,X IRATIOND,ATE 4" / v5 �,(
X
Receipt No.
BY
Received by Date
Recorded by TELEPHONE: (619) 564-2246
r;'
Administrative Authority
t
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
' PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)c
M
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 III
a, .
DATE: rn r Improvement Permit Class IV -
LOCATION OF CONSTRUCTION
1Street-address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
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 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.imployees, 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
E G x.40 ► n(� �lr 3�1��3Cs I
Name of Applicant (please print) c Business Address Telephone No.
�E CCI
72 9e Salvae_A Pe
Name of Contractor and Job Foreman Business Address r : Telephone No.
Contractor's License No. 4 Crty Business License No.
OE- sS Applicant's Insurance Company • Policy Number
FEES: 'Subdivision Improvement Permit= Class III
Public improvements: 3%,of estimated construction cost's °
Private improvements: 39'o°of estimated construction costs
Minor. Improvement Permit'- Class IV: See attached schedule
Inspection Fee $ 'PERMIT VALIDATION
- =`Permit Fee k PERMIT NO.
Penalty
Cash Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE,
TOTAL: $ DATE ISSUED
Receipt No:'
By
Received by Date Administrative Authority
Recorded byTELEPHONE:: (619).564-2246 .