2181-- •ter
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: 5-23-94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-445 Mendoza, La Quinta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION New Home
DESCRIPTION OF CONSTRUCTION Drive way approach
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1-0--14
Sketch (attach construction plans if appropriate)
PER RIVERSIDE CO. STD. 207
(ATTACHED)
MAY 23
1994
APPROXIMATE TIME OF COMPLETION 5-28-94
ESTIMATED CONSTRUCTION COST $ 200.00 ! �Y
(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 ny and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons o roperty
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 result of this work.
Jon M. Walters
P.O. Boz 1637,. La
,/ Signature of Applicant or Agent
pinta, CA 92253 861*4192
Name of Applicant (please print) Business Address Telephone No.
Wes Development Same
Name of Contractor and Job Foreman Business Address Telephone No.
482233 2939
Contractor's License No. City Business License No.
Continental CBP0615 6604
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
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 20.
10.
$ 30.
Received by Date
2181
PERMIT VALIDATION
PERMIT NO. 3181
DATE APPROVED 5-23-94
EXPIRATION DATE 6, 9y�9
DATE I SUE W3-94
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENTI
For the construction of public or private curbs, driveways, Pavements, sidewalks, parking lots, sewers, water maim
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE• Z 3 Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
)LLOCATION OF CONSTRUCTION
(Street address or Description of Location)
URPOSE OF CONSTRUCTION —IV )L Mr
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
')APPROXIMATE TIME WHEN WORK WILL BEGIN
tWPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS --VZ o '
(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:
Indemnify, defend and save the City, its authorized agents, officers. representatives and employees. hamnlea from and against any and all
penalties, liabilities or logs resulting from claims or court action and arising out of any atxidant, logs or
happening or occurring as a proximate rewtt of any work undertaken under the to to Oersom Or propeRy
uant
to
pp ice
Notify the Administrative Authority at least twenty-four (241 hours in advance of the timenwhen work wi i baisstartad. tion.
La Qly
ui with all applicable City Ordditinaneas, the terms and conditions of the permit and all applicable ruin and regulations of the Chy of
V Quints and to pay for any additional replacement necessary as the resultAf this worts.
Sketch (attach construction plans if approprim)
—• —wwl was ug,
m9anz
.saes —UW1 ass
sP4v--kj,d=
2G 3ej
City Business License No.
-- Policy Number
FEES: subdivision 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 1Z d 1
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$
Received by Date
Recorded by
rM
PERMIT -VALIDATION
PERMIT NO. �-l(
DATE APPROVED I z I q`�
EXPIRATION DATE -- 3 I/ 9 7
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
F'?