0079NOTE: . �. .
'With proper validation...
this form constitutes an
encroachment permit CITY OF LA QUINTA
APPLICATION, FOR PERMIT - aj
. -
PUBLIC'WORKS CONSTRUCTION (ENCROACHMENT)
For the ,construction of public or private curbs; 'driveways, pavements, sidewalks, parking lot"s, sewers, water mains,
and'other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS r
Subdivision Improvement Permit — Class III
DATE: January 17. 1985 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-405 Avenida Alvarado
(Street address or Description of Location) '
PURPOSE OF CONSTRUCTION Driveway Apron. Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL 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: S
l .
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
.ti 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
Brian Monroe . 'P.O. 'Box, 1040 la Quinta; CA 92253 564-9190 .�.
Name of Applicant (please print) Business Address Telephone No.
r _ .,Rick Johnson Const. P.O..,Box 2288' Indio, CA 92201 347=7171
Name of .Contractor and Job Foreman Business Address Telephone No.
0'71 Co
Contractor's License No. 1 City Business License No.
A
J Applicant's Insurance Company. Policy:Number r
All Subdivision Improvement Permit — Class I II
Public improvements: 3% of estimated construction costs ,
V Private improvements: 3% of estimated construction costs
Minor Improvement Permif — Class IV,: See attached schedule •'T•"
Inspection Fee $, PERMIT VALIDATION
r 2 0 .00 -
Permit -Fee PERMIT NO. s1180
Penalty r . r 1-17-85
Cash Deposit -Surety Bond � DATE APPROVED '
if required '
EXPIRATION DATE 1-17-86
TOTAL: $ 20.00 .
DATE-ISSU- D 1-17-85
Receipt No.
By 1
Received by Date Administrative Authority
Recorded by ` " TELEPHONE: (619) 564-2246 "3