0160 (2)groper validation
corm constitutes an CITY OF LA QUINTA
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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 I II
DATE: Novenber 15, 1985 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 0 Highland Palm Dr.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION New DrlyeWay Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
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 gulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of t work.
Signature of Applicant or/Agent
Desert Sand and Paving, Inc. P.O. Box 394 Thousand Palms, CA
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 ENTERED NOV Z 4 1985
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
16U
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
30.00
$ 30.00
Date
PERMIT NO.
PERMIT VALIDATION
160
DATE APPROVED 11-15-85
EXPIRATION DATE
DATE ISSUED 11-1�i—q5
By
Administrative Authority
TELEPHONE: (619) 564-2246
............ W,OIV. y &.VU UUL JU U IVY mdy ue I udUlly ano correctly.
be replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the
ties to these monuments shall be furnished to the City. Engineer prior tothe removal of any monuments. This office shall
be notified upon completion of replacement of all survey monuments for proper project clearance.
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