0061NOTE •
Withipropdr validation
this fo"rym constitutes an CITY OF LA QUINTA
encroachment permit.
r APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
..1
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
21 Subdivision Improvement Permit — Class I II
DATE: Nov. $f[. 1984 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION All developed lots in the Westward Ho Subdivison.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Tnstal.l and maintain a Sketch (attach construction plans if appropriate)
nnp !1"1 inch dnmc.sti_c water service.
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 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
C.V. Water District P.O. Box 1058 Coachella, CA 92236 t
Name of Applicant (please print) Business Address Telephone No: 398-2651
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
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 $
Permit Fee No Fee
Penalty _
Cash Deposit -Surety Bond
if required _
TOTAL: $
Receipt No. _
Received by
Recorded by
Date
N®�1
y .
PERMIT VALIDATION
PERMIT NO. N/A '
DATE APPROVED Nextzemher 21 r 1..984
EXPIRATION DATE May 21, 1984
DATEfISSUED NovveymberA21, 1984
By -
4` Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:r
With proper validation
'this form constitutes an
encroachment permit
NOV j,1994
b®MMU% Y DEVELOPMENT DEPT
% E:,Cl C i V* E D
NO\ , 11984
COMMUNITY ®€�€LOPMENT DEPT
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
Subdivision Improvement Permit — Class I II
DATE: Nov. 16, 1984 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION All developed lots in the Westward Ho Subdivison.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Install and maintain a one (1r') Sketch (attach construction plans if appropriate)
inch domestic water service.
DESCRIPTION OF CONSTRUCTION
DIMENSION CF !NSTALLATION 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 employees, harmless from and against any and al:
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 o:
La Quinta and to pay for any additional replacement necessary as the rest09-4kf this work. _
Signature of AppZOACHELLA,
t or Agent
COACHELLA VALLEY WATER DISTRICT P. 0.._Box 1058 CA.19"2236 398-2651
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
Contractor's License No.
Business Address
Telephone No.
City Business License No.
Applicant's Insurance Company Policy Number