0048NOTE:
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 II I
DATE: Sent bpr 10r 1984 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Eiseramer Drive frau avenida Fernando 700' plus South
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION EXtend 22-4er and road Sketch (attach construction plans if appropriate)
bprovements.
DESCRIPTION OF CONSTRUCTION Sewer 440 IF
Curb & gutter 600 LF, ac paving 18,180 SF
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN September 12, 1884
APPROXIMATE TIME OF COMPLETION October 1, 1984
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 rem suli of this work.
)Zu � & Q -
Signature of Applicant or Agent U t'
Imidlxark Land Const. Inc. P.O. BOX 1000 La Quinta, CA 92253 345-2888
Name of Applicant (please print) Business Address Telephone No.
Al Durret Landmark Land Const. Inc. P.O. BOX 1000 La Quinta, CA 340-7973
Name of Contractor and Job Foreman Business Address Telephone No.
B-1 413636
Contractor's License No. City Business License No.
Lynn Hodge - Hum Insurance Ccirpany ® PWC 1091091
Applicant's Insurance Company Policy Number
Lu
M -
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3/0 of estimated construction costs e�a
Private improvements: 3% of estimated construction cos m ® XT -
Minor Improvement Permit — Class IV: See attached schedule 41 Q '148
Inspection Fee $
Permit Fee 420.44
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 420.44
Receipt No.
Received by Date
Recorded by
.A
® PERMIT VALIDATION
1[RMIT NO.
DATE APPROVED ED 3 L'
EXPIRATION DATE — S
DATE,ISSUED
I I
By 01
Administrative Authority
TELEPHONE: (619) 564-2246
I