2120NC,TE:
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
A
DATE: 4/7/94
LOCATION OF CONSTRUCTION 54-785 Juarez
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION nrlvaway Approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 44R/94
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
APPROXIMATE TIME OF COMPLETION_ 4170, 911
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
Sketch (attach construction plans if appropriate)
,,Per Riverside County Standard #207
Attached.
V
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 -res It °of this work
( +,:71 d v
Signature of Applicant or Agent
WFS Aeveionmetn Comna,nv P.O.Box 989 Newcastle. CA 95658 916-663-9167
Name of Applicant (please print) Business Address Telephone No.
Stockman Homes
Name of Contractor and Job Foreman Business Address Telephone No.
On File
Contractor's License No.
On File
City Business License No.
On File On file
Applicant's Insurance Company r 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
Received by
$ — 20.00
10.00
$ 30.00
Date
PERMIT NO.
2120
PERMIT VALIDATION
2120
DATE APPROVED 4/7/94
EXPIRATION DATE
4/22/94
DATE I �UErp 4/1#94 �
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
It
�-
t�
NOTE:
With proper validation
this form constitutes an
encroachment aermrt
CITY OF LA QUINTA..
APPLICATION FOR PERMIT
-PUBLIC WORKS CONSTRUCTION' (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lou, severs, watir meirs
and other like public works -improvements in.connection.with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE:—. y / i �L/ Subdivision Improvement Permit — Chis 111
_ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 5Y — `l 9J J�14 ✓-c e,
(Street address or Description of Loation#
PURPOSE OF CONSTRUCTION �/'/�-w �
Sketch (attach construction plans if appropriaq)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION ZJ
ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction. materials, and debris, backfilling, com.
Paetion and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indwmmty, defend and save the City. its authorized agents, officers. rtpress"'tim and «nploym. harmless from and against
peneltres. Inabilities or loss resulting from tlsirq or court action and arisi env ertd all
happening or occurring a a proaiwate rerun of a me Out Of any aCGdent. IOss or damage to persofu or prapaity
rev wort undertaken under the permit granted Oursuant to this application.
Notify the Adm�n�tiretrve Authority at least twenty-four (24) hours in advance of the time when wort will be started.
Comply with all applicable City Ordinances, the arms and conditions of the permit and all applicable rola and Mutations of the City Of
V Quina and to pay for any additiww reWaar+ent neceawy as the result of this wort.
cll�S a2�qyvM.e_%
Name of Applicant (piease print)
Name of Contractor and Job Foreman
Contractor's Ll se No.
signature of Applicant or Agent
V9 ?VCz jCi*-s Re, CC—
�S�f
Business Address
Business Address
,-j 4a,",
9i(. — 0(,3 —Sic7
Telephone No.
Telephone No.
./G
City Business Licen o.
Applicant's Insurance Company ,rl. -c--
Polity NumbiK
FEES: Subalvislon Improvement Permit —Class I11
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
:ash Oeposit-Surety Bond
if required
TOTAL: S
1ecaipt No. .
3eceived by Date
lecorded by
PERMIT VALIDATION
PERMIT NO.
DATE
x
EXPIRAT N DATE
DATFI UED
By
Administrative Authority
TELEPHONE: (619) 564-2246
� <O