0132 (2)NOTE:
-With proper validation ' Q
this form constitutes an
CITY OF LA QUINTA
encroachment permit $�
APPLICATION FOR PERMIT
PUBLIC,WORKS CONSTRUCTION (ENCROACHMENT) �� I•n��Sw�ti
• - . `�';l � r � SOF ��
For the -construction of public or.'private curbs, driveways, pavements, sidewalks, parking �lots,� sewers, water mains ,
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and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.-
Subdivision- Improvement Permit —Class I I I '
DATE: s June 21., 1985 Minor Improvement Permit Class IV
,LOCATION OF CONSTRUCTION Avenida Fernando '
(Street addressor Description of Location) '
PSS' '(attach construction plans if -appropriate)'
PURPOSE OF CONSTRUCTION ettrreet f "k,
'
DESCRIPTI�QN OF CONSTRUCTION Remme stmng pave�men �Q�"' F.�E_ ' /SaZ.�• - - ,
Const. 3 A.C. pavement,oconstruct type "A „
6 type D curb. f +-
DIMENSION OF INSTALLATION OR REMOVAL `
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40
SIZE OF EXCAVATION, IF NEEDED r
,x APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
_ ESTIMATED CONSTRUCTION COST $
,.. (Including removal of,all obstruction,'materials, and debris, backfilling, com- ,
{ paction ands placing permanent resurfacing and/or replacing improvements) i
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 Quin' and to pay for any additional replacement necessary as the result of this work.
r
` Sig ature.of Applicant or Agent (J
Anden-00pr. P.O. Box 780 La Quinta, CA 92253 564=1315
Name of Applicant (please print) -Business Address Telephone No.
Name of Contractor.and Job Foreman Business Address Telephone No.
LV +
Contractor's License No. " City Business License No. .} F
•
Applicant's Insurance Company . Policy Number 7
. r
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of estimated construction costs
• Private improvements: 3% of estimated construction costs. "'" ";
Minor Improvement Permit — Class IV: See attached schedule `"�
Inspection Fee 't $ •PERMIT VALIDATION {
Permit Fee 375,27�� }
(• f PERMIT NO.. _
Penalty DATE APPROVED 6-21-85
Cash Deposit -Surety Bond, /
if required EXPIRATION DATE
TOTAL: $ 375.'27
' `g��sI
DATE ISSUED 7,�
, - '
Receipt No.
By ,
Received by Date Administrative Authority
p•.. `
Recorded b 7
Y TELEPHONE: (619) 564-2246. I ' -
•s
C:0 AC.H:ELLA VALLEY
WATE-R DISTRICT
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e �o
Coachella, California 92236: Post Office Box 1058 Telephone 619)32651
TO: CSD 27 '. /iD L.>�
DATE 19 8� .
..FILE. NO.
7 S S C GL
lD .� �-�Esr��o
RE: gw 0 C /7 ,.
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L v,,J ,* CA
(A(/twiD�4
WE ARE-.SENDING YOU:
ATTACHED
CHANGE ORDER,.
PRINTS
COPY OF LETTER
RECEIVED, SHOP-DRAWINGS
REPORTS
PLANS*
ANALYTICAL DATA
AUG i 19136 SPECIFICATIONS
OTHER
SAMPLES
SHIPPED SEPARATELY VIA
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPT
+
Copies - Date
Description
a
THESE ARE:TRANSMITTED•AS CHECKED BELOW:
FOR APPROVAL
RETURN CORRECTED PRINTS
APPROVED AAS SUBMITTED
FOR YOUR USE
APPROVED AS NOTED -
AS REQUESTED
RETURNED FOR.CORRECTIONS
FOR REVIEW•AND°COMMENT
RESUBMIT 'COPIES FOR APPROVAL
'FOR BIDS DUE 1982
SUBMIT COPIES FOR,DISTRIBUTION
PRINTS RETURNED AFTER LOAN TO '
US"
REMARKS , �L �,¢.l CX Te^l b
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.4T O D
79 19
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Yours very.truly,
CVWD-378
(Rev. 8/84)