3721NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit '
APPLICATION 'FOR PERMIT
PUBLIC WORKS CONSTRUCTION .(ENCROACHMENT)
b
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
C 19,2002 Subdivision Improvement Permit— Class III
DATE: Minor Improvement Permit Class IV
LOCATION -OF CONSTRUCTION ftp$it VatO= U4 t ielk @ AVen " DUS and Ca]L" T"Se lm
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION "pE'r "atBr Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION ate' c0c "Pa'a` t Cana' MM ATTaCM SPECIAL» 001MITIORS
excAvate a make leper re s, bath fM a" CoomCt.
DIMENSION OF INSTALLATION OR REMOVAL _` a Tt•
SIZE.OF EXCAVATION, IF NEEDED 8 ft• x e ft.
APPROXIMATE TIME WHEN WORK WILL BEGIN S Alil4m etit, 0�
APPROXIMATE TIME OF COMPLETION 30 8eptesUr• 2002
,,,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, 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 result of this work. :r t
Signature of, -Applicant or Agent 7
CoachelU Valley Water Diatrict PO 30% 10$8 Colas CA 92236 760.398„2651
Name of Applicant (please print) Business Address Telephone No.
Erie Urbm sem as aba"
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License'No.
City Business License No.
Applicant's Insurance Company Policy Number
•e.
FEES
-'
Subdivision'lmprovement Permit — Class I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
I
Minor. Improvement Permit — Class IV: See attached schedule
Inspection Fee $ NO M
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
Received by Date
Recorded by
i I WA
221 i 37
PERMIT VALIDATION
3721
PERMIT NO.
DATE APPROVED August 19 `2002
October 19, 2002
EXPIRATION DATE
DAT E �I.S.�SyU E D August 19, 2002
By
Victor. Nma AdministAtive Authority
Telephone: (760) 777-7075
k,
NOTE:
With 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
. Aurmt 19,2002 Subdivision Improvement Permit —Class I I I
DATE:
TE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION R!WLIE xaClr *&xn 16A # 01ax and Call* T wate%U
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION tat' �M11� Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION UIAS, AWWU+L Sti AMCM SPUD' ;T1011111111111
to .l to*. aspsat tlm S"M virrlalwilt f ptww"t
DIMENSION OF INSTALLATION OR REMOVAL * tt-v X A tt"
SIZE OF EXCAVATION, IF NEEDED a It. x Is tt*
APPROXIMATE TIME WHEN WORK WILL BEGIN t9 Axt• 2002
APPROXIMATE TIME OF COMPLETION Pc"Oer, xWC
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, 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 result of this work.
Signature of Applicant or Agent
COSWO .la 1►All+Y Wat*'c 0tatrftt 10 WX 1054 Ce: wholla• CA 922U 760.398.2631
Name of Applicant (please print) Business Address Telephone No.
Erie ft**A' now ar abM0
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
l
Applicant's Insurance Company Policy Number
L
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
No 1111119
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
1
Receipt No.
Received by
$
Date
T 3721
PERMIT VALIDATION
PERMIT NO.
/ll><tr "t 19, 1002
DATE APPROVED
EXPIRATION DATE
!w>tYut>C IV, CUVA
DATE ISSUED
By .., "�� ::_ _ ,
Administrative Authority
Recorded by 11 Telephone: (760) 777-7075