0108'NOTE: M.
With proper validation 04
this form constitutes an
'< h CITY OF LA QUINTA
encroac ment permit
APPLICATION FOR' PERMIT _
' PUBLIC WORKS CONSTRIOCTIbN, (ENCROACHMENT) �� '• �Sw4:
0 T[��
For the construction of public or private, curbs, driveways, pavements, sidewalks, parking lots, 'sewers,rwater mains
,and other like public works improvements ,in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS ,
t
Subdivision Improvement Permit — Class I I I
DATE: April 11,'1985 * Minor Improvement Permit Class,IV M.
LOCATION OF CONSTRUCTION 48-860 Eisetr nrive r -
(Street address or Description of Location) t
PURPOSE OF CONSTRUCTION D**Veway Apron Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
} k
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, I.F NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN t
APPROXIMATE TIME OF COMPLETION ;-
ESTIMATED CONSTRUCTION COST $
(Including removal of all..obstruction, materials, and debris, backfilling, com-
paction.
om 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.
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. t.
P 141,14
Signature'of Applicant or Agent
Rick Johnson Const. P.O. Box 2288' Indio, CA 92201 347-7171
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.
Applicant's Insurance Company Policy Number
,r
FEES: Subdivision Improvement Permit — Class III' ° t +• ��'
Public improvements: 3% of estimated construction costs .y
Private improvements: 3% of estimated construction costs
Minor Improvement Permit —Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION* .
Per ' it Fee 20.00 1324 `
} PERMIT NO. '
Penalty
• Cash Deposit -Surety Bond DATE APPROVED ArJril '11."'1985
if required
• {. EXPIRATIO-
N DATE W/p8xmit ,•
TOTAL: 20.00 ;
$: 'DATE ISSUED
'Receipt No. T
BY•
Received by Date } ° Administrative Authority r
Recorded by TELEPHONE: (619) 564-2246
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