0141 (3)E:!
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With prIjOer valuation
this form constitutes an CITY • OF' LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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:' 3-19-53 Minor Improvement Permit Class IV 1,
LOCATION OF CONSTRUCTION --I`/- D— me, Palms. :.90 .:/0 Fred Dr. 11ract 1990"1
}1l0 �# 549-71302I
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION ` �.cn:ririr- I�r•t f ar caviC�
DESCRIPTION OF CONSTRUCTION STA.ici in load case.
DIMENSION OF INSTALLATION OR REMOVAL 4. x 4' splice.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 10-1-85
Sketch. (attach construction plans if appropriate)
comp
APPROXIMATE TIME OF COMPLETION 1-30-66
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
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.
General Tele
, Name of Applicant (please print)
of Ca.
Chun Ruiz
Signature of Applicant or Agent
83-793 Darreon Dr. Blvd. Indio, CA 347-8775
Business Address
Te
No.
Name of Contractor and Job Foreman Business Address, Telephone No.
Contractor's License No. 17 City Business License No.
Applicant's Insurance Company , Policy Number
FEES: Subdivision Improvement Permit - Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs ENTERED NOV 2. 5 1985
Minor Improvement Permit — Class IV: See attached schedule N W
Inspection Fee $ -- INCA II PERMIT VALIDATION
Permit Fee 'I
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ NIA
Receipt No. {
Received by
Recorded by
Date_
PERMIT NO. 141
DATE APPROVED 1-24-8.5.
EXPIRATION DATE 1-30-86
DATE ISSUED n7-2
/112-8.5 _
,
By
Arlnistrative Authority
TELEPHONE: (619) 564-2246
ftecoraea Dy II TELEPHONE: (619) 564.2246
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