01240l6TE: /
,With proper validation p4
this form cc;-istitv`tes an CITY OF LA' QUINTA ; • ~ �
encroachment permit �:
APPLICATIONFOR FOR PERMIT
PUBLIC WORKS CONSTRUCTION*(ENCROACHMENT)
o
For the construction of public or '
p private curbs, driveways, sidewalks,;parking lots, sewers, water. mains
+ and other like publ.ic works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
20 1985 Subdivision Improvement Permit —,Class III X
May Y Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION PGA west Project Site (PGA BLVD.').
Jefferson St. SIO Ave. 54
+ (Street address or Description of Location)
PURPOSE OF CONSTRUCTION Street k2rOVeTentS Sketch (attach construction plans if appropriate)
DESCRIPTION'O'F CONSTRUCTION ' 0-14b gutter, ,AC PaVing, etc.
DIMENSION OF INSTALLATION OR REMOVAL' See plans ,
Plans On File
SIZE OF EXCAVATION, IF NEEDED See plans
APPROXIMATE TIME WHEN WORK WILL BEGIN 5-20-85'
APPROXIMATE TIME OF COMPLETION 9-30-85 '
k •
ESTIMATED, CONSTRUCTION COST $ •507.634.00
(Including removal of all obstruction, materials, and debris, backfilling, Co. m-
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 andI all 4
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:
• i
Comply with all applicable_ City Ordinances,'the terms and conditions of the permit andall applicable rules arid regulations of the City of '
La Quinta and to pay'for any additional replacement necessary as the result, of this work.
.. CSignature'oof Applicant or Agent
Lanctnark Land Co. P.O. BOX 1000 IE Qui.nta, ''''CA ,:92253 345-2888
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job,Foreman Business Address j Telephone No. .
Contractor's License No. F City Business License No.
Applicant's Insurance Company, t• Policy Number _
FEES: Subdivision Improvement Permit — Class III '
Public improvements: 3% of estimated construction costs 4 ;a
.Private improvements: 3%'of estimated construction costs
• Minor Improvement Permit.— Class IV: See attached. schedule
incl. e.
Inspection Fee $ PERMIT VALIDATION ,
Permit`Fee 9,•576:34 _
124
PERMIT NO.
Penalty 5-20=85
Cash Deposit -Surety Bond +' DATE APPROVED
if required~
t
- .EXPIRATION DATE 9-30785
9, 576.34
TOTAL: $ DATE ISSUED t
Receipt No. �. +
H . By ,
;Received by Date / .. Administrative Authority .
Recorded by TELEPHONE: (619) 564 2246 \
k
�j-
LA QUINTA HOTEL - LANDMARK DETACH AND RETAIN THIS STATEMENT
LA QUINTA, CALIFORNIA THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED BELOW.
IF NOT CORRECT PLEASE NOTIFY US PROMPTLY. NO RECEIPT DESIRED.
HOTELLANDMARK-
,
&;TRUSTCOMPANy. ICI, a,,..• r 1 78p
,".ONE STATE STREETf
4 -��.-,NEW YORK, NEW260
YORK 10015—,
P 0.
Boi 1000 Za' Quiito;Califd;4&iu 92253-1
DATI I
c No.
HE NET AMOUNT
PA "
PAY -
9i576.34.
! 'tk
NINE 'THOUSAND JIVE�i' HUNDRED S DOLLAR'S TA Ni
LAaUINTA GENERAL ACCOUNT
TO
A
ORDER
�QU.IXTA
OF. p 1504,i-,
LA0 T
uxN
17
92353
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1190L113132110 11:026007829: SE106 1000118
nn--;n3n9 D27, RKLLAW QXPANT'
VOUCHER
INVOICE
PURCHASE
''INVOICE
AMOUNT
DISCOUNT
NET AMOUNT
NUMBER
NUMBER
ORDER
DATE
-D22046`.D220W
05-,22-�-85
-9#,576-34"
.00
.90576�34'
: PGA' -BLVD:
O
T.-576
-S
9,P576 34',
-013,
'34'
LA QUINTA HOTEL - LANDMARK DETACH AND RETAIN THIS STATEMENT
LA QUINTA, CALIFORNIA THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED BELOW.
IF NOT CORRECT PLEASE NOTIFY US PROMPTLY. NO RECEIPT DESIRED.
HOTELLANDMARK-
,
&;TRUSTCOMPANy. ICI, a,,..• r 1 78p
,".ONE STATE STREETf
4 -��.-,NEW YORK, NEW260
YORK 10015—,
P 0.
Boi 1000 Za' Quiito;Califd;4&iu 92253-1
DATI I
c No.
HE NET AMOUNT
PA "
PAY -
9i576.34.
! 'tk
NINE 'THOUSAND JIVE�i' HUNDRED S DOLLAR'S TA Ni
LAaUINTA GENERAL ACCOUNT
TO
A
ORDER
�QU.IXTA
OF. p 1504,i-,
LA0 T
uxN
17
92353
z
1190L113132110 11:026007829: SE106 1000118