0084NOTE:
With proper validation -• .
'r
this form constitutes an
CITY` OF LA QUINTA
encroachment permit ,�,:,,.,„.•..�r -� '"
APPLICATION -FOR"PERMIT' '�
PUBLIC WORKS -CONSTRUCTION (ENCROACHMENT)
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
IfDATE: January 25, 198; i
V6
LOCATION OF CONSTRUC,T1001 54th.- ar.
.r s
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
w-13 .Ann
•tt
(Street address or Description of Location)
PURPOSE OF CON STRUCTI,ON•' Stmt .Inproyements
Sketch (attach construction plans if appropriate)
DESCRIPTION O:E�,105NSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED '
APPROXIMATE TIME WHEN WORK WILL BEGIN 1-28-85
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ '
(Including removal of all obst#ction, materials, and debris,. backfilling, com-• ;
paction• and placing -*permanent resurfacing and/or replacing improvements) t
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.
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 Cityof
ti . La Quinta and to pay for any additional replacement necessary as the result of this work.
�Signature�of Applicant or Agent
Lloyd Watwn P.O:„BOX 1000 La Quints, CA 92253 345-2888..
Name of Applicant (please print) Business Address` Telephone No.
Lancfinark Land Co. .,
' 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 I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit —Class IV: See attached schedule
Ins ection Fee
p $ •. PERMIT VALIDATION
Permit Fee 8,625.00 n/a
PERMIT NO.
Penalty
Cash Deposit -Surety Bond DATE -APPROVED 1-25-85
if required y. EXPIRATION DAT E•I-25-85-
TOTAL: $ 8,625.00 r
DATE ISSUED
Receipt No. ^�
By
Received' by Date F Administrative Authority
Recorded by =1 TELEPHONE: (619) 564-2246 • .