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1705NO'a'E 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: 3/29/93 LOCATION OF CONSTRUCTION 53-300 Ave Madero (Street address or Description of Location) Subdivision Improvement Permit — Class III Minor Improvement Permit Class IV PURPOSE OF CONSTRUCTION Driveway ARDroach,< Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Per Riverside County STD # 207 DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 3/93 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. Sig e o pplicant or Agent Jay M. Nolan 27 Joya Dr Palm Desert, CA 92260 564-52.51 Name of Applicant (please print) Business Address Telephone No. SAME Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business License No. StaeeFarm Ins (RomeOwners) 55—JO-092.3-5 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 Received by $ 10.00 20.00 $30.00 W, Date ?85' 8?A§A 10YSTUT-93 30.00'0 #705 PERMIT VALIDATION PERMIT NO. 1705 DATE APPROVED 3/29/93 EXPIRATION DATE 4/1/93 DATE,ISSU�ED 31 9103 By T l iJV4/� Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 NOTE: With proper validation this form constitutes an encroachment permit CITY OF LA OUINTA 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 o�� %� Subdivision Improvement Permit — Class III OATE:- Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION S.3 3 © Or/E �YI.4i5 E2 O (Street address or Description of Location) PURPOSE OF CONSTRUCTION 0 4 G �I 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 S (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: Sketch (attach construction plans if appropriate) Indemnity, 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 V Quinta and to pay for any additional replacement necesmry as the result of this work. - E9i:�fr� . Signat a Ap nt or Agent I� Name of Applicant (pleai(e print) Name of Contractor and J& Foreman Contractor's License No. Business Address Business Address Telephone No. Telephone No. _ City Business License No. Applicant's Insurance Company 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 $ Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by Date Recorded by 1 vU�J PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE: (619) 564-2246