0081" NOTE:
With proper validation - • i:' 4 Q
' this form constitutes an.
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CITY OF LA :QUINTA `s
encroachment permit v
APPLICATION -FOR - PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT). t.T;,mSw4�
OF
For the construction of public or private curbs,, driveways, pavements,' sidewalks; parking lots, sewers, water mains
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and other, like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
" Subdivision lmproverrient Permit— Class III
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DATE: ,TantaRry 1:7r 1985_ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-701; Avanicia MPndn7.a + ,
(Street address or,Description of Location) .• f
PURPOSE OF CONSTRUCTION Drive y APS Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION.OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED x.
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t
'APPROXIMATE TIME,WHEN WORK WILL BEGIN
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APPROXIMATE TIME OF COMPLETION
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ESTIMATED CONSTRUCTION COST,$
(Including removal of all obstruction, materials, and debris, backfilling, com
placing
paction and p g permanent resurfacing and/or replacing improvements)', -
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In consideration of .the granting of this permit, the applicant hereby agrees to: y
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.;.
f Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.-
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Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable "rules and regulations of the City of
La Quints and to -pay for any additional replacement necessary as the result.of this work.=
A0 zlr_�_7
Signature of Applicant or Agentj-
�y
Brian Monroe P.O. Box 1040 La.QLinta, CA 92253 - 564 9190, '
Name of Applicant (please print) Business Address Telephone No.
Rick Johnson Const. P.O. Box 2288 Indio, CA 92202 347-7171
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Name'of Contractor and Job Foreman Business Address Telephone No..
Contractor's License No. City Business License No.'
Applicant's Insurance Company , Policy Number
FEES: Subdivision Improvement Permit —Class III y JAN `•. ' s
Public improvements: 3% of estimated construction costs' «_
Private improvements: 3% of estimated construction costs t ' •� --R
• Minor Improvement Permit —Class IU: See attached schedule
* Inspection, Fee $ PERMIT VALIDATION
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Permit Fee' . 20.00*PERMIT 1184
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NO.
Penalty E' 1-17-85
Cash Deposit -Surety Bond DATE APPROVED
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' if required EXPIRATION DATE ` -1-17-86
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TOTAL: $ 20.00
- DATE ISSUE'D�
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Receipt No. I N1�11_x�_
Received by Date'" Administrative Authority
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Recorded'by TELEPHONE: (619) 564-2246 ,