0101NOTE: ..,
With proper validation
-this form constitutes an CITY OF LA - OUINTA
encroachment permit
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 .
1 XX
April 9, 1985 Subdivision Improvement Permit —Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION — Trac*- if 19903 - Horizon Palms - Fred Waring & Dune Palms
(Street address or Description df Location)
PURPOSE OF CONSTRUCTION Suib&vision .improveml�nts
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION sii-e/affsite imps—n e—arnnts
DIMENSION OF INSTALLATION OR REMOVAL see plans Plans on File
SIZE OF EXCAVATION, IF NEEDED see plans
APPROXIMATE TIME WHEN WORK WILL BEGIN April 15. 1985
APPROXIMATE TIME OF COMPLETION EX -421- 30- 1985
ESTIMATED CONSTRUCTION COST $ 737.RRF-00
(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 arid 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"orules and regulations of the City'of
La Quinta and to pay for any additional replacement necessary as the result of this work. / f�
Name of Applicant (please print)
Signature of, ppl' ant�or Agent
Business Ad
Telephone No.
J L Construction 74-399 Hiahwav_111 Palm Desert, CA 92260 619-340-5511
Name of Contractor and Job Foreman Business Address Telephone No.
95-3846979 237
contractor's License No. ) U City Business License No.
Aetna Casmlty / 83 CK957014 CPA
r.Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule 1,`� +�,T
0
�-o
Inspection Fee
Permit Fee
$ , Tnclk .
$ 11,878.86
Penalty
ash Deposit -Surety Bond
0�f required n/a
TOTAL: $ 11,878.86
cteceipt No.
V
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 101
DATE APPROVED 4/4/85
EXPIRATION DATE 12/30/85
DATE ISSUED 4/9/8
Adminlstrative Authority
TELEPHONE: (619) 564-2246