1363NOTE:
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
February 19, 1992 Subdivision Improvement Permit — Class II I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION ' 51-885, 51-895, 51-905, and -51-925 Rubio, La Quinta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Asphalt approaches from street Sketch (attach construction plans if appropriate)
to drive way
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 161 err 2(tel
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 2/20/92
APPROXIMATE TIME OF COMPLETION 2/20/92
ESTIMATED CONSTRUCTION COST $ 4800.00
(Including removal of all obstruction, materials, and debris, backfilling, com-
pactlon 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.
Y �°..�6 74.,t,
Signature of Applicant or Agent
Neil BAker 66164 San Juan Desert Hot Springs, CA 251-2468
Name of Applicant (please print) Business Address Telephone No.
Desert Asphalt 320-5121
Name of Contractor and Job Foreman Business Address Telephone No.
389974 } 2248
Contractor's License No. ) City Business License No.
Cromell & Menne MCP0916169-03
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: s3% 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.
$ 80.00
40.00
$ 120.00
Received by Date
1363
00151 82 CIA03 1? 'DWl2Oi 92 i 20.000
PERMIT VALIDATION
PERMIT NO. 1363
DATE APPROVED 2/19/92
EXPIRATION DATE 71 /92
DATE IS UE 2/19/92
By
Administrative Authority
Recorded by 11 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
U Subdivision Improvement Permit -Class I II
DATE:_ / Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION — 5L q SSS _ S/- u / S 'V-90-5,9,2 5�-
(Street address or Description of Locatig )
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
fa ,-,'✓e r, ate►
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL /VL " X o2 D
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ;2-20-9Z
12-.00 , 5.•00 0W%
APPROXIMATE TIME OF COMPLETION --x'20- 11
ESTIMATED CONSTRUCTION COST $ 4K00- pO
(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.
Y �Sb / Siign/ature o pplicant or Agent `
I/ OG/Ce/6 /7 SA r. �J(
riGti n %� ,25V—a 75/ 2
.Name of Applicant (please print) Business Address Telephone No.
Dese.r�' 1500�6, alp ?.2e) - l
Name of Contractor and Job Foreman Business Address Telephone No.
399 9 y y �7i`-{ g
Contractor's License No. City Business License No,
C/'Amel/ ge AenYt // cV ! / � f V / /y�
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ L5'D o 0
40 . Do
$- 1Z-0,00
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
1350
Administrative Authority