0120NOTE:
With proper validation
this form constitutes an ~ -
CITY OF LA, QUINTA
encroachment permit ,. � ►� � 1
APPLICATION • FOR 'PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT•)��
OF
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
DATE: I May 15; 1985 Minor,lmprovement Permit Class IV
,^ LOCATION OF CONSTRUCTION 46-414 Roudel Lane
' La Quinta, CA 92253 •-
(Street addresrs or Description of Location) t • � ' ,
PURPOSE IF CONSTRUCTION., Driveway. Apron Sketch (attach construction plans if appropriate)
DESCRIPTION -OF CONSTRUCTION -
DIMENSION OF INSTALLATION OR REMOVAL
S12E OF EXCAVATION, IF NEEDED
APPROXIMATE'TIME WHEN WORK WILL BEGIN ' •!
APPROXIMATE TIME OF COMPLETION +
,ESTIMATED CONSTRUCTION COST $ - k
(Including, removal of all obstruction, materials, and debris, backfilling,'com-
paction .and placing permanent resurfacing and/or replacing improvements) h�
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 Quints and to pay for any additional replacement necessary as the result of this work:
A4
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Signature of Applicant or.Agen
'Daniel Ferquson 46-275.000ti110 Drive- -Palm Desert,.CA.92260 '
Name of Applicant (please print) Business Address Telephone No.. '
Nanie of Contractor and Job Foreman ,Business Address Telephone No. `
4 r �
Contractor's License No. City Business License No.
Applicant's Insurance Company at i. Policy Number 1 ,
FEES: Subdivision Improvement Permit — Class I II + '
Public improvements: -3% of estimated construction costs ► a� .'
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule _® ,
Inspection Fee $ PERMIT VALIDATION
Permit Fee 20.00 t 1287
PERMIT -NO.
Penalty DATE APPROVED 3-15-85
Cash Deposit -Surety Bond 1 r
if required - W/t•
. EXPIRATION DATE
TOTAL: $ 2LOO
OO
+ DATE. .D
Receipt No.
By
Received by Date ? . • Administr'ative Authorit
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Recorded by TELEPHONE: (619) 564-2246
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