2116.NOTE:
/ t•
Nlth.�r,;per validation
his 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
DATE: 3/31/94
LOCATION OF CONSTRUCTION 54-550 Avenida Diaz
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 20' x 5'
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
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:
Sketch (attach construction plans if appropriate)
Per Riverside County Standard #207
P31 1994 D
BY -t n �
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 per . and all app c rules and gulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of is wor
Sig ature of Appl ant or Agent
Sterling Homes P.O.Box 450, La Quinta -564-1866
Name of Applicant (please print) Business Address Telephone No.
Lendal Ventures
Name of Contractor and Job Foreman Business Address Telephone No.
B-638935 859
Contractor's License No. City Business License No.
Gold Eagle ZNsuranee 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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 20.00
10.00
$ 30.00
Received by Date
2116
PERMIT VALIDATION
PERMIT NO. 2116
DATE APPROVED 3/31/94
EXPIRATION DATE'
DATE ISS ED 3/31194
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
2
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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, sewer, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
GATE: 3/--��/ Subdivision Improvement Permit — Class III
Mjnor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Stns address or Desawtmn of t.ocationl n
PURPOSE OF CONSTRUCTION
Sketch fattach 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 COMPLETION
ESTIMATED CONSTRUCTION COST S
(lnduding 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:
Indwnnrfy. defend and save the City, its authorized agoras. officers. reDniefi atiws and alnptoyees, harmless from+ and against anti and MI
penalties, liabilities or Ion resulting from ciauru or court action and arising out of any aoadent, loss Or
darrap happening or Occurring as a proximate mutt of any wort u KM ken under the permit to persona or prppeny
Notify the Administrative Authority at least r~ f granted Oursuant t0 tfiia a00lice ion.
ty our 124) hours in advance of the time when .Orta II be
Comas with all a0plieable City ordinances, the term and conditions of the of
V Quints and to pay for any additional rt Soarnem necessary as the mutt of
Name of Applicant
Name of Contractor and Job Foreman
A - /,p� P
Contractor's License No.
Business Address
wt aertad.
¢ Telephone No.
O
City Business License No.
Applicant's Insurance pany C� 7
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
?ermit Fee
'enalty
ash Oeposit•Surety Bond
f required
TOTAL:
3eceipt No.
E
S
3eceived by Date.
3ecorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPR,QWVED
EXPIRA ON DATE
I
OATS LIED
By '��
Administrative Authority
TELEPHONE: (619) 564.2246
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