0053NOTE:
With proper validation
14.
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
DATE: October 3, 1984
LOCATION OF CONSTRUCTION Tract 20218 — Calle Norte
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV X
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Street Curb, .gutters, Sketch (attach construction plans if appropriate)
cat,7pr t ra -ar _
DESCRIPTION OF CONSTRUCTION Sewer water Street Const.
DIMENSION OF INSTALLATION OR REMOVALApprOX' 1500 ft.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 60,333.00
(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 resulto� work.
Signature of Applicant or Agent
Dc�kl&�Developmnt Corp. 182 Calle Norte 5(630
Name of Applicant (please print) Business Address Telephone No.
Applicant
Name of Contractor and Job Foreman Business Address Telephone No.'i,I�"
Contractor's License No.
..a{F
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs O
Minor Improvement Permit rClass.IV: See attached schedule �'. 53
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
1,810.00
$ 1,810.00
Date
i
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED Q=t1Q04
EXPIRATION DATE Anrx1, 3. 1984�y
DATE ISSUED
By -
Administrative Authority
TELEPHONE: (619) 564-2246