0086c i
.. NOTE:-
With
OTE: With proper. validation + x r� • �4. 2
this form constitutes an o
CITY. OF LA QUINTA
encroachment permit.
APPLICATION FOR PERMIT
,.,
' a PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) � '•�""'� '�
OF TF189wSw
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 I
February 15, 1985 ; • Subdivision Improvement Permit — Class. I I
DATE: r Minor Improvement'Permit,Class IV
LOCATION OF CONSTRUCTION
52-945 Avenida Navarro i
(Street address or Description of Location)
v
PURPOSE OF CONSTRUCTIOND—ri ewav 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 r`
' APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com y
,.•paction and placing permanent resurfacing and/or replacing improvements) '
In consideration of the granting•of this permit,'the applicant hereby agrees to-
Indemnify, -defend
o:Indemnify,-defend and save the City, its authorised agents, officers, representatives4and employees; harmless. frori "and against any and all
penalties, liabilities or loss resulting from claims or court action and arisingout of an _ $
y 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 City' of ?
-La Quinta and to pay for any additional replacement necessary as the result-of this work.
Signature of Applicant or Agent
Mike read 5' 4&82e;: .�/ 171 ���i/! 561P 1 34llsS 2
- Zx
Name of Applicant (pleaW print) 6usiness'Address Telephone No.: ;
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
Public improvements: 3% of estimated construction costs "` [flF!` A" I D FE198'
Private improvements: 3% of estimated construction costs'
,. Minor Improvement Permit =Class IV: See attached schedule 08.6r
t - A
Inspection Fee $ PERMIT VALIDATION
Permit'Fee 20.00 001226
PERMIT N0.
Penalty: Febn=y' 15 1985,
Cash Deposit-Surety Bond, DATE APPROVED
if •required EXPIRATIONDATE Auaust 15. 1985 I
. A i
a
TOTAL: $ 20."60
DATE-ISSUED -�
Receipt No. - �—
Received by Date . • Administrative* Authority +
Recorded by ' TELEPHONE: (619) 564=2246