2146With proper validation
this 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: -4-19-94
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-415 a O OS2�,tl
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Construct Drive Approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 4"20-94
APPROXIMATE TIME OF COMPLETION 5-10-94
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 Co. Std No. 207
(attached)
APR 9^
By
U
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/fhe time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and aLl ap rca a rules and g"ulations of the City of
La Quinta and to pay for any additional replacement necessary as the results of this work.
re of Applicant or
Sterling Homes P.O.Box 450 LA Quinta CA 92253 549--1866
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
B-638335 859
Contractor's License No. City Business License No.
Golden Eagle 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
Permit Fee 10
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30
Receipt No.
Received by Date
Recorded by
2146
PERMIT VALIDATION
2146
PERMIT NO
DATE APPROVED 4-19-94
EXPIRATION DATE 5-10-94
DATE ISSX�EDJ 4,r19-94
By _.,,...
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an
encroachment oermrt 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 Ruins
and other like public works imprOvements:in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
GATE: Subdivision Improvement Permit — Clan III
LOCATION OF CONSTRUCTION �y/� O �� Minor Improvement Permit Clas: IV
(Street address or Description of Lootion)
PURPOSE OF CONSTRUCTION — AWAY&W
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION -2-x Zo W,61*
DIMENSION OF INSTALLATION OR REMOVAL
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.
Pa bon and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
tndNtlnofv. defend and save the City. its audhon2ed a"- - officers, neorenntathm and employees, harmlen from and
penelnes. I1abilitia or Ion rmiting from damp or court action and srisi out of a e�in s eny end all
happening or occumng as a oroxan tte
result of a nq ny acudant. Ion or dsmega to persona or prOp�Ity
Inv Work undertaken under the permit granted oursuant to this aoolieetion.
Notiflr the Administrative Authority at least ewenN•four (24) hours in advanp of�the time when
Coetpry with all spOlicabis City Ordinanoet, the terns end canditioflf of the pensfit end all �k sill be stared.
La Quints and to psy for env addntional replaeernent neeenry es the result of the world aoofieibl• rulesregulations of tshe GN of
Name of
(please print)
Name of Contractor and Job Foreman
6 3?33.�-
Contractor's License No.
of App(icWit or
Business Address
Telephone No.
Business Address Telephone No.
City Business License No.
Applicant's Insurance Company �C� AZO �/ / I — W
Policy Number
FEES: Suborvlslon Improvement Permit — C1ass II I
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 Deposit -Surety Bond
if required
TOTAL.
Receipt No.
S
leceived by
Date
lecorded by -----------------
PERMIT VALIDATION
PERMIT NO.
DATE APPR6VED
EXPIPA ON DATE
.. i
DATE WED
By ��
Administrative Authority
TELEPHONE: (619) 5642246