2080NtiOTE:
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
Subdivision Improvement Permit — Class I I I
DATE: 2/24/94 Minor Improvement Permit Class IV
LOCATION.OF CONSTRUCTION 54-960 Avemida Rubio
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION DrivaFn Annroarh Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
Per Riverside County Standard #207
DIMENSION OF INSTALLATION OR REMOVAL 201x51
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 2/25/94
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:
pFEB 41994
D
FEB
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and agal.nst 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 nd all applicable ru 2s and regulatio�of/theCiyof
La Quinta and to pay for any additional replacement necessary as the result of � work. //
.� ,Z /// `/ /�/.,/ — /
of Applicani orAgent
_ Sterling Homes P.O.Box 450 La Quints 564-1866
Name of Applicant (please print) Business Address Telephone No.
Lendel Ventures
Name of Contractor and Job Foreman Business Address Telephone No.
B-638535 859
Contractor's License No. City Business License No.
Goldjagle Ins. CCP -203971-00
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 $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO
DATE APPROVED 2/24/94
EXPIRATION DATE 3/1$/94
2080
DATE ISSUED —2/24h94
By 71O ^/P---,'
Administrative Authority
TELEPHONE: (619) 564-2246
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
DATE:
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit —Class I I I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 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
APPROXIMATE TIME OF COMPLETIONZ Vp Q/Z
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, representativesInd 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 124) 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
Name of Applicant (please print) Business Address Telephone No.
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 i
M.inor Improvement Permit — Class IV: See attached schedule.
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond:
if required
TOTAL: $
Receipt No.
Received by Date
PERMIT NO.
DATE APPROVED
EXPIRATION DATE T
DATE ISSUED
By
Recorded by 11 TELEPHONE: (619) 564-2246
Administrative Authority
w �w