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0149 (3)NOTE With,prapery Tdation this .form constitutes an encroach'me`nt permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) i 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: S pta-ib r 13, 1985 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION �;t-rppt• ng on T(-ff`crson approx 400' N/O Ave 54, also greet crossing on Ave 54 aero 40' W/O Madison and 400' south on Madison. (Street address or Description of Location) PURPOSE OF CONSTRUCTION Prnviefa fac i 1 i t iPs for rP Sketch (attach construction plans if appropriate) at i nn a_rt_i_ nia i nt_ _ hl dc; - for PCS' [.Vest. DESCRIPTION OF CONSTRUCTION' 2 Street rros;s jM's and .4nnof hiiried rah1P. DIMENSION OF INSTALLATION OR REMOVAL ren _h to 14 aWrox. flr fl' lnn� 3h" aP-p 24" wicip. 'F SIZE OF EXCAVATION,•IF NEEDED 1i"'e plt ONMI APPROXIMATE TIME WHEN WORK WILL BEGIN 1.0-15-85 APPROXIMATE TIME OF COMPLETION r • 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 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. Signature of Applicant or Agent General 7].ele-i: !one -23--7-,'3 Dr. Carreon R1.yd. Indio, CA 92201 341--8771. Name of Applicant (please print) Business Address - Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business. License No. Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class III Public improvements: 3% of estimated construction costs ENTERED NOV 2 5 1985 Private improvements: 3% of estimated construction. costs Minor Improvement Permit — Class IV: See attached schedule j 9 Inspection Fee $ N/A PERMIT VALIDATION Permit Fee PERMIT.NO. 149 Penalty DATE APPROVED 9-13-85 Cash Deposit -Surety Bond if required EXPIRATION DATE 11-30-85 TOTAL: $ D SUED Receipt No. BY Received by Date Administrative Authority Recorded by TELEPHONE: (619) 564-2246 �flu �� Lg � GEORGE H. CHANEY CO. Inspection Services a r v THE FOLLOWING,WAS NOTED: DATE &" 6 N • , {_-2-6,G � JOS NO. • ,t .4 ` f PROJECT DESCRIPTION S rAr—r�irS LOCATION CONTRACTOR WEATHER a FROM TO -HRS FROM TO HRS - ra TOTAL y MO. 237 Q 0 /L-PI'rt ©AJAZ- s ►� ,q-� p4i;-ft-^Atr-race. 'cf --3o.-8"S' a,i,-rim aPr exp Lo; Nr-Aibtl$jkJ46 , Ift a. t �. COPIES TO:. • ` SIGNED A. WHITE - CLIENT, YELLOW - FIELD FILE, PINK - OFFICE FILE y� . .. � � � � �! «R.. � � � c 9r S � -.