1983-008 (AC)NOTE: ,
With proper validation ;
•this -form constitutes an CITY OF LA , QUINTA '
encroachment per
'APPLICATION FOR PERMIT.
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction sof 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 II
DATE~- June 20, 1983 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 47225 Washington Street, La Quinta, CA 92253
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION IT Pr6Vei[1MtS — Per Plan + Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Per Plan
DIMENSION OF INSTALLATION OR REMOVAL Per Plan
r
3
SIZE OF EXCAVATION, IF NEEDED Per Plan
APPROXIMATE TIME WHEN WORK WILL BEGIN ASAP
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: ~
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,timefwhen work will be started. '
Comply with all applicable City. Ordinances, the terms and conditions ofthe perms 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 -568-9411
Church of St. Francis of AssiEli, 42-600 Bob HopwDrive, Suite 115, Rancho Mirage, CA 92270
Name of Applicant (please print) Business Address. Telephone No.
W. D. Gott Construction- 1656 E. 9th Street, Upland, CA 91786 (714) 982-8951
Name of Contractor and Job Foreman Business Address Telephone No.
279688 City of`La Quinta'License .#(039
Contractor's' License No. City Business License No.
State Cnsation Insurance Fund : 390779-82
Applicant's Insurance Company Policy•Number
FEES: Subdivision Improvement Permit —Class' III
Public improvements: 3% of estimated construction costs .
Private improvements: 3% of estimated construction costs "-
0ry8
Minor Improvement Permit — Class IV: See attached schedule ° "
Inspection Fee $ II PERMIT VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 616.14
Receipt No. •2 07
Received bL Date
Recorded by
� Y ,
PERMIT NO. �o
DATE APPROVED
EXPIRATION DATE
DATE I/SSSS%
By
Administrative Authority
TELEPHONE: (619)564-2246
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Building Dept.
P.O. BQ.x 1504
La Qu°i'nta, Ca.
92253
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