0049NOTE:
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 II
DATE: September 12, 1984 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Eisenhower Drive between Avenida Fernando and the
La Quinta Hotel entry.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
etch (attach copstruction plans if appropriate)
DESCRIPTION OF CONSTRUCTION TO install curb, clutter &
street nave—out ner anoroved plans.
DIMENSION OF INSTALLATION OR REMOVAL Install 614 L.F.APPROVED STREET
,Sltof curb and gutter. remove 7941 sa. ft. of asnhaalt„ TNTPDVEffiqT PLANS.
install 18.881 sa. ft. pavement on base. I \
SIZE OF EXCAVATION, IF NEEDED None
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION uctoner LW4 �._✓
ESTIMATED CONSTRUCTION COST $ 28,000
(Including removal of all obstruction, materials, and debris, backf ljing com-
paction and placing permanent resurfacing and/or replacing improvements)
eom�ents)
In consideration of the granting of this permit, the applicant hereby'avees 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
Landmark Lund Company P.O. Box 1000 La Quinta, CA 92253 345-2888
Name of Applicant (please print) Business Address Telephone No.
Landmark Land Ccgmny (Dave Green) P.O. Box 1000 La Quinta, CA 92253 345-2888
Name of Contractor and Job Foreman Business Address Telephone No.
B-1 413636
Contractor's License No. City Business License No.
.Lynn Hodue - Home Insurance Ccmpany PWC 1091091
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit
Public improvements: 3% of estimated construction costs
Private improvements: 3% oh\!U[natee P nstrt�/ction costs 6 949
Minor Improvement Permit — Class IsV: See a�ached schedule
Inspection Fee $ 1,140.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: 'Its -
Receipt
Receipt No.
Received by
Recorded by
Date
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authority