2184NO 1,
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
Subdivision Improvement Permit — Class I I I
DATE: 5-24-80 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-585 Ramirez
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach. 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 5-24-94
PER RIVERSIDE CO. STD. 207
ATTACHED
APPROXIMATE TIME OF COMPLETION 5-25-94 i
ESTIMATED CONSTRUCTION COST $ ( P'JIAY 94
(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\he permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the resu4t of this work. -
Signature of Applicant or Agent
Belknap Const. P.O. Box 297, La Quinta, CA 92253 364-278
Name of Applicant (please print) Business Address Telephone No.
James Belknap 341-2271
Name of Contractor and Job Foreman Business Address Telephone No.
652815 2845
Contractor's License No. City Business License No.
Farmers Newport Beach, CA
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
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
$ 20.
10.
$ 30.
Date
PERMIT NO
2184
PERMIT VALIDATION
2184
DATE APPROVED 5-24-94
EXPIRATION DATE 5-31-94
DATE IS UED AP -24-94
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
Do
ti.
I.} 1,J
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 lou, sewers, water main$
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
V-
YDATE: �— —
nLOCATION OF C NSTRUCTION
(Street address or Oesaiptlon of Location)
PURPOSE OF CONSTRUCTION
AutSGRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
PROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction, materials, and debris, backfilling, com-
Paetion and placing permanent resurfacing and/or replacing improvements)
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if approprillitill)
In consideration of the granting of this permit, the applicant hereby agrees to:
Inde . nov. defend and saw the City, its authorized agents, officers, reOresarttstives and amOloyaes. harmless from and
penass lties, liabilities or loresulting from Claims Or court action and arising out of any O=dent, Ion Or a9iiMt amy and all
happening or occurring as a proximte aresult of any work undertaken under Me damage to parsons or prppeRy
Notify the Administrative Authority at least twenty-four Permit granted Pursuant to this application.
ty our (241 hours in
Comply with all apOliabla City Ordinances, the terms and conditions
La Quints and to pay for any additional replaartertt necessary as the
Name ck ApplicantA aWprint)
Of the time when work will be started.
Permit and all aPPlieable rules and regulations of the City of
Of this wort.--'
Applicant fir
Telephone No.
N me of ontractor and Job Fore n viZ 7
Business Address Telephone No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company
Policy Number
FEES: Subalvislon Improvement Permit — Class II I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
I nspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: .
Receipt No.
$
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO
T
DATE APPROVED - "�\ AA\ G `�
EXPIRATION DATE _
DATE ISSUED �.
By
Administrative Authority
TELEPHONE: (619) 564.2246
0
1
0