0087NOTE:
'717 r y�
With,proper validation = _ Q
-this form constitutes an
CITY OF LA OUINTA o
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
op
For
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`
Subdivision Improvement Permit— Class III
r.
DATE: F'ebLlta?'y 1.9, 1985 Minor Improvement Permit Class IV
LOCATIONOF- CONSTRUCTION 51-625 Eisenhower_ i
(Street address or Description of Location) t
PURPOSE OF CONSTRUCTION Driveway Apron' Sketch (attach construction. plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL ,
i SIZE OF EXCAVATION, IF NEEDED -
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ l '.
(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:
+, 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.
.R Notify the Administrative Authority at least twenty-four (24) hours in•advance of the time when work will be started. t
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 this work. y ,
• Signature of Applicant or Agent
Desert Design P.O. BOX 1420 La Quir&a, CA 92253
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No. ,
Contractor's License No. - City Business License No.
Applicarit's.lnsurance Company Policy Number
FEES: Subdivision Improvement Permit - Class III
Public improvements: 3% of estimated construction costs.,
Private improvements: 3% of estimated construction costs
NA - •r m 4 j -
Inspection Fee• $
Permit Fee 20.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No. W
Received by Date
Recorded by ,
PERMIT VALIDATION
PERMIT NO. 1231
DATE APPROVED 2"19-85
EXPIRATION DATE .2-19-.85
DATE -ISSUED
By
Administrative Authority �.
TELEPHONE:.,(619) 564-2246