1831NOTE: � , i
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: 8/9/93
LOCATION OF CONSTRUCTION 54-300 Herrera La Quint&
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION DriveiM AD11resrh 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
PER RIVERSIDE COMM S1tD #207
pAUG 0 g 1293 �
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 applicatiot.n.;, ie
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.
Sign—617Applicant or Agent
Rich VarAaa
Name of Applicant (please print) Business Address Telephone No.
r
Same
Name of Contractor and Job Foreman li Business Address Telephone No.
On bile
Contractor's License No.
On Pita
City Business License No.
On File On File
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 $ 10.900
Permit Fee 20.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
1831
PERMIT VALIDATION
PERMIT NO. 1831
DATE APPROVED 8/9/93
EXPIRATION DATE 8/13/93
DATE ISSUED 8/9/93
By 41�Lo _" )bwl
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
-'~
@k P
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 Curtin, driveways, pavements, sidewalks, parking lots, sevwrs, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: , Subdivision Improvement Permit - Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S Y- 3 0 0 r f
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION A o,or o s Sketch (attach constructionIan: if appropriate)
ppropriate)
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 saw the City, it: aurt►ori:td agents, officers, repntsentstives and employees, harmless from and against any aall
happening or occurring as a proximate result of and
Penalties. liabilities or Ion resulting from claims or court action and arising out of any accident, loss or
any work undertaken under the damage to persons or property
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 rtartad.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quints and to pay for any additional replacement nec"Ury as the result of this work.
rA I` % � -S
Name of Applicant (please print)
Name of Contractor and Job Foreman
Contractor's License No.
Signature pplicant or Agent
Business Address
Telephone No.
Business Address Telephone No.
City Business License No.
Applicant's Insurance Company
Policy Number
FEES: Suborvislon 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.
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
Received by Date BY
Administrative Authority
Recorded by TELEPHONE: (619) 564-2246