1815"I
NOA:
With pFoPer"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
7/23/93 Subdivision Improvement Permit — Class I II
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-805 Juarez'
(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 7/26/93
PER RIVERSIDE COUNTY STD 101 207 -.
My_��
r APPROXIMATE TIME OF COMPLETION 7128/93
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
r
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 beN started.
r
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
Wes Development Co 77885 Montezuma La Quints (619) 564-5154
Name of Applicant (please print) Business Address Telephone No.
Walter Stockman
Name of Contractor and Job Foreman Business Address Telephone No.
On File On File
Contractor's License No. City Business License No.
On File On File
.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 1815
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$ 20.00
10.00
$ 30.00
Receipt No.
Received by Date
PERMIT VALIDATION
PERMIT NO. 1815
DATE APPROVED 7/26/93
EXPIRATION DATE 7/30/93
DATE ISSUED 7/26/93
By,t P .�
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
1
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 lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
ti
DATE: Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S _ V.S [J✓C,
1
(Street addrsts or Oesenption of Location)
PURPOSE OF CONSTRUCTION , vrl�Wti`t v
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION - v
DIMENSION OF INSTALLATION OR REMOVAL 2�
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 tht granting of this permit, the applicant hereby agrees to:
Indemnify, defend and cave the City. its authorired agents, officers. representatives and employees, harmless from and spinsi •
Penalties, liabilities or lots resulting from clams or court action and arisi nY and all
h8c4mming or occurring as a proximate result of. a ►'0 Out Of any accident. (Off Or damage to perlons or 0,o Iry
^y work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twentyfour (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 at
La Quints and to pav for any, idditionjo-a4sceff"t nMtMrV as the result of this work.
Name of Applicant (plelse print)
it r? ' i _ i / 141A t1%
Name of Contractor and Job F roman
Contractor's License No.
__tetacL J ItR'CLI L Sw5 L.
�w�• spy •
Signature of Applicant or Agent
i i a&) / N �r�f e. � t✓►�t.� /�vz- s � y -S"1 Sri
5� .%;4At8usrness Address Telephone No.
Business Address Telephone No.
ZS -3 Ll
CityBusineesss License No.
0
Applicant's Insurance Company Ilcn b W 0 1 1
Policy Number
FEES: Subolvislon 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 $ �d
Permit Fee /
Penaltv
Cash Deposit -Surety Bond
if required
TOTAL: $ cam/
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 7 2, r�3
EXPIRATION DATE _ 7-30-13
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564.2248
" A . � , ) � '- i , " �*