0073,..,, J .: wi .. - � .' 's' •!' :fit' _ .. {}♦" +•! •' . R, � .�. .'.
NOTE:
With proper validation
O
this form constitutes an m r
CITY OF: LA: QUINTA
encroachment permit •'�-
APPLICATION FOR PERMIT
PUBLIC •WORKS CONSTRUCTION' (ENCROACHMENT)��
0 Tf189
-.For the' construction of public.tor privam 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 Permits— Class
DATE: January 3, 1985 Minor Improvement Permit Class,.IV
LOCATION OF CONSTRUCTION 48-721 can Vincxm to Stxp!p_t
.(Street address or Description of Location) ,
e aY
PURPOSE OF CONSTRUCTION DriyApron Sketch (attach construction plans if appropriate)
' DESCRIPTION OF CONSTRUCTION t
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATETIME WHEN WORK,WIILL. BEGIN
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, harmIess'fro'm and against any and all" +y
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..
r Comply with all applicable City Ordinances, the terms and conditions ofd 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! ,-
.• Sigriature of Applicant or Agent. t.
Joe Foster 81-750 Zerl, CA 92274 ' .
.AZrpo
Name of Applicant (please print) Business Address Telephone No.
Spates Construction 85=431 Middleton Rd. Tharma1 �_ 342-2724' +
-'Name of Contractor and Job Foreman Business Address Telephone No.'
Contractor's License.No.' City Business License No.
,Applicant's Insurance Company Policy Number
j FEES:' Subdivision Improvement,Permit'-'Class III s
` 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 VALIDATION
Permit Fee - 20, 00 001161. ,
PERMIT NO.
Penalty January 3,' 1985
dashDeposit-SuretyBond DATE APPROVED - j
if required - EXPIRATION DATE January 3, 1986
TOTAL: $ 20e00 '
DATE ISSUED. ,
Receipt No.
By t
Received by Date Administrative,Authority
- Recorded by TELEPHONE: (619) 564-2246
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