0144?NOTE:
With proper v .idati' ^�
MIS form cons titutes'ari 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 X
DATE: August 7, 1985 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Ave. 54.W/0 Jefferson St. (PGA West) .
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION —Street I?Mroyements Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION • AC PavinQ'PCC Curb and
Otter, drainage i=rovements.. •` PLANS ON FILE
.DIMENSION OF INSTALLATION OR REMOVAplans
' SIZE OF'.EXCAVATION, IF NEEDED — See plans
APPROXIMATE TIME WHEN WORK WILL BEGIN 8-9`85 .
I r
APPROXIMATE TIME OF COMPLETION • 12-31-85
' ESTIMATED CONSTRUCTION COST $ _66,828.00
,(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 rk. - I
/S+/gna ur f Applicant or Agent
Landmark Land Co. P.O. Boat 10U0' , La Quinta,• CA 564 -644.6 -
Name of Applicant (please print)`" Business Address Telephone No.
samE;
Name of Contractor and Job Foreman Business Address - Telephone No. '
on file • 133
Contractor's License No. City Business License No. .
on file on file
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 1 fl
Minor Improvement 4
ent Permit — Class IV: See attached schedule a
Inspection Fee $ 2r004.114 PERMIT VALIDATION
m
Permit Fee PERMIT NO. 0144 r
Penalty. DATE -APPROVED 8-7-85
Cash Deposit Surety. Bond
if required
EXPIRATION DATE
TOTAL: $ 7. DC4.Rd • •DATE ISSIJ�ED
Receipt No.
Received by Date "00� tAdministrative'Authority . .
Recorded by TELEPHONE: (619) 564-2246
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