005211.E
NOTE: F
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
Subdivision Improvement Permit -Class I II •
DATE: �'-Y 3, 1984 Minor Improvement Permit Class IV X
LOCATION OF CONSTRUCTION Westerly Washington Street So. Ave. 50
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION TnM-al lation of fie�wer- Line
DESCRIPTION OF CONSTRUCTION .g+e-r TAM Cb"st..
DIMENSION OF INSTALLATION OR REMOVAL - 1264 T,.F.
SIZE OF EXCAVATION,•IF NEEDED 96
APPROXIMATE TIME WHEN WORK WILL BEGIN Oct' -ober 1. 1984
Sketch (attach. construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION MtnhPr 29^ 1984
ESTIMATED CONSTRUCTION COST $ 100; 000.00
(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
landmark Land -Co. of California P.O. Box 1000 I,a Quinta, CA 345-2888
Name of Applicant (please print) Business Address Telephone No.
Lloyd W. Watson P.O. Box 1000 Ia Quinta, CA 345-2888
Name of Contractor and Job Foreman Business Address Telephone No. ,
413636
Contractor's License No.
841464
City Business License No.
Td-nnt� Hodoe Insurance ,
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
Minor Improvement Permit - Class IV: See attached schedule
Inspection Fee $`
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required '
TOTAL:
Receipt No.
Received by
Recorded by
316.00
$_ -4lti_nn
Date
® X52
PERMIT VALIDATION
PERMIT NO. -0
DATE APPROVED Oct. 1, 1984
EXPI RATION DATE��� 1 1 s u19R
DATE -ISSUED i n - -3,69 1
By— rl
Administrative Authority
TELEPHONE: (619) 564-2246