0149 (2)/.;i,pr- opervalidation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
7�
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
DATE: Sei~teirwer 13, 1985
Subdivision Improvement Permit —Class II I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION i na on 'Tpffc-rson g1pprox 400' N/O Ave 54, also
s=eet crossing an Ave 54 apprDx. 40' W/0 Madison and 400' south on Madison.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION P oyirh fac•iI i ties for fire Sketch (attach construction plans if appropriate)
altatic_m an:] rrywint_ h1dg_ for PQA flegt_
DESCRIPTION OF CONSTRUCTION 2 l-eet' oaain 's and
40()' of htiri _d r-ahle_
DIMENSION OF INSTALLATION OR REMOVAL trIMCh to I)e rox.
14A,11 In--)(; 'i(;" 24" wide-,
SIZE OF EXCAVATION, IF NEEDED =1ice "'cam Pit
APPROXIMATE TIME WHEN WORK WILL BEGIN 10-15-85
1
APPROXIMATE TIME OF COMPLETION 1.0-30-85
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:
COiMF�E�TIED
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 Ieasp 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.
VCi_
Signature of Applicant or Agent
rT. Carreon P.lvd. Indio, CA 92201 347-8771.
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
Contractor's License No.
Business Address
Telephone No.
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
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ N/A
Received by Date
ENTERED NOV 2 5 1985
149
PERMIT VALIDATION
PERMIT NO. 149
DATE APPROVED 9-13-85
EXPIRATION DATE 11-30-85
D SUED
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246