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0074i NOT E: With proper validation this form constitutes an ti' '• • �,�`° encroachment permit CITY OF LA QUINTA r �i. A APPLICATION FOR ,PERMIT • PUBLIC' WORKS .CONSTRUCTION (ENCROACHMENT) t� �.„n •t gw� OF ` 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 I I DATE: January 17, 1985, i Minor Improvement Permit Class';IV f• ! x Y • LOCATION OF CONSTRUCTION 53-915 Avenida Villa • � �' (Street address or Description„of Location) ' Apron _ PURPOSE OF CONSTRUCTION Driveway, .. Sketch (attach construction plans if appropriate)r - DESCRIPTION OF CONSTRUCTION ,• DIMENSION OF INSTALLATION, OR REMOVAL' A SIZE. OF EXCAVATION, IF NEEDED ' APPROXIMATE TIME WHEN WORK WILL BEGIN ' a APPROXIMATE,T'IME OF COMPLETION - ESTIMATED CONSTRUCTION COST $ ', (Including removal,of all obstruction, materials, and debris, backfilling, com < paction and placing permanent resurfacing and/orr, 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. r' Notify 'the Administrative Authority at least twenty-four' (24) hours in advance of the -time when work' will be started. f 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! ” Brian DlOnroe`- P.O. BOX 1040 La Quinta, CA' 92253 { Name of Applicant (please print) Business Address Telephone No. Riak'Johnson'COnst.t P.O. BOX'2288 Indio, CA 92202 347-7171 Name of Contractor and Job Foreman ; -Business Address Telephone,No. 397169 Contractor's License No. y City'Business License No. M Applicant's Insurance Company • • ' Policy,Number i FEES: Subdivision Improvement Permit_- Class 111. 1985 f P ' ,,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 , •©.0 Permit Fee ' , . `, PERMIT NO. . • Penalty. Cash Deposit -Surety Bond DATE APPROVED ' if required EXPIRATION DATE TOTAL: • $ ,„ DAT.E-ISSUED, Receipt No."', ^ Received byDate ' '� ' ' TAdministrative`Authority' Recorded'by `" TELEPHONE: (619) 564-2246 '