0157,� - - - y. -, �r Ufa •''- ��•" _ � �
-Malidation
is form constitutes an ,CITY•• OF iLA QUINTA
encroachment permit
.
-APPLICATION FOR PERMIT �
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
t OF.TH$9w
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: October 23, 1985 Minor Improvement Permit Class IV
LOCATION,OF CONSTRUCTION In island at c:ornen of Calle ;Estado and,Bezmudas.
(Street address or Description of Location) "„
'PURPOSE OF CONSTRUCTION To advertise La Quinta
Sketch (attach construction plans if appropriate)
Historical Society Fundraiser. ,
DESCRIPTION OF CONSTRUCTION Plastic.sicin approx. �
9 •feet' lona.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED n/a
APPROXIMATE TIME WHEN WORK WILL BEGINwill be installed
Thursday Oct. 24, 1985. ,
APPROXIMATE TIME OF COMPLETION will be. remved Oct. 27; 85. '
ESTIMATED CONSTRUCTION COST $ n/a
(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 m ;
La Quinta and to pay for any additional replacement necessary as the result of this work. s
Signature of Applicant orrAgent • i
La Quinta Historical Society P.O. Box 1283• • La:4
Quinta, CA 92253 ''564-646
Name of Applicant (please print) Business Address Telephone No. T
- Bob Peixce same y
Name of Contractor and Job Foreman :. Business Address Telephone No.
na na 4 .
Contractor's License No. ` City Business License No.
Applicant's Insurance Company . - Policy Number
FEES: Subdivision"Improvement Permit — Class III Y Y }
Public improvements: 3% of estimated construction costs. y
Private improvements: 3% of estimated construction costs ,? t
,Minor Improvement Permit — Class IV: See attached schedule �+� �� ;
Inspection Fee $ t PERMIT VALIDATION r
Permit Fee PEES WAD7E6/NO. CONDITIONS.
157
{
.. PERMIT NO.
Penalty y 10-23-85
Cash Deposit -Surety Bond DATE APPROVED • ,ff ,;
if required EXPIRATION DATE 10-28-85 t
TOTAL:... $ DATE ISSUED
Receipt No.
By
Received by Date f . Administrative Authority
Recorded TELEPHONE: (619) 564-2246 r ('