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With proper validation ; • - 0,�, :'
this form constitutes an
CITY OF' LA'-QUINTA
encroachment permit -- 4
APPLICATION FOR .PERMIT -
PUBLIC WORKS CONSTRU_CTION_. (ENCROACHMENT) I•„�p ��
OF
t For Ithe construction' of public or 4 "
p 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: ' JanuarV 17, 1985 Minor Improvement Per,mit.Class IV
F F,
LOCATION OF CONSTRUCTION 53-725 .Avenida Mendoza
(Street "address or Description of Location)
PURPOSE OF, CONSTRUCTION, Driveway Apron ,Sketch (attach constructiornplans if appro nate
DESCRIPTION OF CONSTRUCTION :r
DIMENSION.,OF.INSTALLATION OR REMOVAL" .'
SIZE OF.EXCAVATION, IF NEEDED ,
APPROXIMATE TIME WHEN WORK WILL BEGIN s, „
APPROXIMATE TIME. OF COMPLETION i
ESTIMATED CONSTRUCTION_ COST`$
(Including removal of all obstruction, materials, and debris; backfilling; com-
paction
om 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 undertakenunder: the permit granted pursuant to this application. +
Notify'the Administrative Authority at least twenty-fo6r,(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 allapplicable rules and, regulations'of'the City of '
La Quinta and topay for any additional replacement necessary as the result, of this work.,
• l//A'
�. Signature of Applicant or, Agent
Brian Monroe: P.O. Box 104.0 La 2tunta, CA 92253 564'-9190 L.
Name of Applicant (please print) Business Address Telephone No. ,
'Rick Johnson Const. P.O. Box 2288 Indio` CA 92202 347-7171
Name of Contractor and Job Foreman r Business Address Telephone.No.
Contractor's License No.' City Business License No. ,
Applicant's Insurance. Company Policy Number , ;f
FEES: Subdivision Improvement Permit — Class" I I I' x- • ^ VD, JA'v 1 99
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 9D "hn ' PERMIT NO. 1185
Penalty r j µ
Cash Deposit -Surety Bond -' DATE APPROVED 1-17=85 '
if required •1-17-86
EXPIRATION DATE
TOTAL: $' a^-, is 1-17-85
DAT -ISSUED'
Receipt No.
By . _n0.
Received by' Date Administrative Authority,,'
;Recorded by TELEPHONE: (619) 564-2246