0109°NOTE--
4.
With proper -validation,
- this form constitutes'an
CITY' OF, LA .QUINTA .
•encroachment permit . ' � v
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83 �
APPLICATION FOR PERMIT �
PUBLIC WORKS CONSTROftrON "(ENCROACHMENT) _ ; •" .' c S
OF
AI
y For the construction of public. or private• -curbs, driveways, pavements, sidewalks, parking lots, sewers, water
.mains
- and other, like, public works improvements in'connection witWUNOR IMPROVEMENTS and'APPROVED SUBDIVISIONS !'
` Subdivision Improvement Permit*—' Class III '
DATE: A'bril 12, 1985' Minor Improvement Permit Class fV x
LOCATION OF CONSTRUCTION Calle Chillon - various locations:
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(Street address or Description of Location)' R , "-
PURPOSE OF CONSTRUCTION Wates' line inStallatidh- • Sketch (attach construction plans if appropriate)
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DESCRIPTION OF CONSTRUCTION See plans. {' : PLANS ON FILE
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f ail
DIMENSION OF INSTALLATION OR REMOVAL See Plans
SIZE OF EXCAVATION, IF NEEDED See Plans
APPROXIMATE TIME -WHEN WORK WILL BEGIN
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'APPROXIMATE TIME OF COMPLETION
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' ESTIMATED CONSTRUCTION COST $
(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 '
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penalties, liabilities 'or 'loss 'resulting from claims or court action and arising out of any accident, loss.or damage to persons or property.
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happening or occurring Ias 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 r�
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La Quinta and to pay for any additional replacement necessary as the result of this work.
R.L. MCDOWell
Signature of Applicant or Agent,
Ccenpany., ;, 78-040 Calle La Fonda' a .564-4426
Southem, California Water_
Name of Applicant (please print) Business Address Telephone No.
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M & J Pipeline - Jim.Reynolds. P.O. Box 325 Nbrongo,VMl.ey, CA 363-7521
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Name of Contractor and Job Foreman ' Business Address Telephone No.
' On file . On f11A
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Contractor's License No. City Business License No..
On File i On, file r`
Applicant's Insurance Company Policy,Number
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FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction co§ts • '
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Private improvements: 3%0 of estimated construction costs - q
Minor Improvement Permit — Class IV: See attached schedule
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F Inspection Fee $ 83.20 PERMIT VALIDATION
" Permit Fee 10.,00 � 109.
.:: PERMIT NO. -
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Penalty 4-12=85
Cash Deposit -Surety Bond DATE APPROVED
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if required EXPIRATION DATE5—�R—RS
_ TOTAL: $
• DATE ISSUED 4? -12-85
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Receipt No. a.
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Received by. Date ,; r r Administrative Authority
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• Recorded by' t 'TELEPHONE: (619) 564-2246 •
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