0094NOT.E:w-,
»
r. With proper'validation ` • '� 4 Q
this form constitutes an CITY OF LA QUINTA
encroachment permit
'
APPLICATION FOR PERMIT
' PUBLIC WORKS CONSTRUCTION (ENCROACHMENT).- � �c S •
w�
�t'.►?OF�ti
• 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 andAPPROVED SUBDIVISIONS
r ♦Subdivision Improvement Permit — Class `I I I
�5,
DATE: March 1985- Minor Improvement,Permit Class'IV
LOCATION OF CONSTRUCTION 53-399. Avenida Herrera = T
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION DriveWay Apron Sketch (attach construction plans if 'appropriate)
DESCRIPTION,OF CONSTRUCTION '. ' • F
' �'
• — 4j
s
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
'APPROXIMATE TIME OF COMPLETION {'
ESTIMATED CONSTRUCTION COST $
(Including removal of. all obstruction, materials, and debris, backfilling, com
• paction and placing permanent resurfacing and/or replacing improvements) r '
:In consideration of'the granting of this permit, the applicant hereby agrees to:
Indemnify,.defend and'save the City, its authorised agents,',officers, representatives and.employees, harmlessifrom and.against-any and all `ir. • •
penalties, liabilities or. loss. resulting from claims-or,court action and arising out of any accident, loss or da mage 'to'personsor 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 twerity-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-th"is ork.
• Signature of App Icant or Agent
0
__ Ri �k ,TcihnRnn (bnRt.' P.O. Box 2288 Indio, CA 92201 847=7171 .
Name of Applicant (please print) _ ! Business Address " - , Telephone No."
Name of Contractor and Job Foreman Business Address _ Telephone No '
Contractors License No. ? 'City Business License No.,
Applicant's Insurance Company Policy -Number 3
'
FEES: Subdivision Improvement Permit — Class I I I •
t
,
Public improvements: 3% of estimated construction costs
Private :improvements: 3% of estimated construction costs .
MI ;
'
•x_94 . , .
Minor Improvement Permit — Class IV: See attached schedule" . - •
,•
Inspection Fee ;$ _ + PERMIT VALIDATION' -
Permit Fee 70 nn. `` r`♦ .1248
PERMIT NO.
Penalty - •' r'DATE
APPROVED Malrch 5. 1985 �' t
Cash Deposit -Surety Bond -
y
if required
EXPIRATION DATE In con-(• W/pll�Illt + s'
TOTAL: $ 20.00 ,e•
�DAT``E:,IS``S��UED' R
(l 1 •'
'
Receipt No. i C fJCk:,..� + C,
t
By �x
Received by . •Date _ Administrative Authority'..
(619 )• t +,
Wit, 64 2246
' Recorded by TELEPHONE: 5
-v ly;'