1813t.L.
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
E
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 III
DATE: 7/23/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-565 Eisenhower
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION IW -V.•
PER RIVERSIDE COUNTY STD # 207
DIMENSION OF INSTALLATION OR REMOVAL #
SIZE OF EXCAVATION, IF NEEDED D q
APPROXIMATE TIME WHEN WORK WILL BEGIN 7/26/93 JUC 26 1993
APPROXIMATE TIME OF COMPLETION 7/28/93 sy
r
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) f
In consideration of the granting of this permit, the applicant hereby agrees to:
O
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 oo-f,this
Jwork.
Signature of Applicant or Agent
Wes Development Co 77885 Montezuma La Quinta (619) 564-5154
Name of Applicant (please print) Business Address Telephone No.
Walter Stockman
Name of Contractor and Job Foreman Business Address Telephone No.
642348
Contractor's License No.
2534
City Business License No.
Scottsdale Ins GLS 486817
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 20.00
10.00
$ 30.00
Date
1813
PERMIT VALIDATION
PERMIT NO. 1833
DATE APPROVED 7/26/93
EXPIRATION DATE 7/30/93
DATE ISSUED 7/26/93
ByAM C> (.tt
Administrative Authority
TELEPHONE: (619) 564-2246
J
NOTE:
With proper validation
this form constitutes in
encroachment permit CITY OF LA QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, panting lots, sewers, water ntiins
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: ? Subdivision Improvement Permit — Class 111
Minor Improvement Permit Chis IV
LOCATION OF CONSTRUCTION _ .��I — 5�.� cL) ��.,,��v-
(Street addreu or Oescriviion of Location)
PURPOSE OF CONSTRUCTION CJrlvt tl-/+ v
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION rAAL, S'tg
oIlk
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION ?.b�
ESTIMATED CONSTRUCTION COSTS 'kqD:
(Including removal of 411 obstruction, materials, and debris, b3ckfilli —_
�' com-
paction and Placing permanent resurfacing and/or replacing improvements)
In consideration of thk 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 naintt any and all
penalties. Liabilities or Ion resulting from claims or court action and arising out of any accident, lots or darnage to persons on propoity
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this ion.
applicat
Notify the Adminirtrstive Authority at lean twenty•four 1241 hours in advanp of the time when wort will be started.
(adnal
Comply with all applieaDfe City Ordinn
seet, the termt andConconditionsof the permit end all aoOlicaWe rules end regUletiopq o} the City of
La Quints and to pay for any ditioreplacarment necessary as the result of this wort.
'
Signature of Applicant or Agent
Name of Applicant (please print) 4-7&S%O��9J
usines Address
4114
Telephone No.
Name of Contractor and Job F roman _-
Business Address Telephone No.
Contractor's License No.
City Business License No.
3 i�" At,, z �ws (.o . S 1
Applicants Insurance Company G 19 LI g(9
�t Policy Number
FEES: Subolvlslon Improve_ P
ent ermit — Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimaied construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Oeposit•Surety Bond
if required
TOTAL:
Receipt No.
/0
Received by Datb
Recorded by
PERMIT VALIDATION
PERMIT NO
DATE APPROVED — —7 r Z & —q:5
EXPIRATION DATE '7-3o—q,3
DATE ISSUED ,�y 3
By
Administrative Authority
TELEPHONE: (6191564-2248
I
v"I
0