0161 (2)NO�E�" •'
With pr r validation
this form cefnstitutes an
encroachnsant per"tYtit
CITY OF LA QUINTA
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
DATE. T'1yyuiber 19, .19 S
LOCATION OF CONSTRUCTION ,-,--910 1-d(triland Palms Dr.
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION N&,j Dri,iew-1y 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 regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result oft s work.
ature of Applicant or Agent
P9 t
Desei t Sand and Paving, Inc. P.O. Bax 391 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 ENTER
Public improvements: 3% of estimated construction costs ED NOV 2 4 1985
Private improvements: 3% of estimated construction costs
Minor Improvement Permit —Class IV: See attached schedule
M, 161
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ -1 (1 r")
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 161
DATE APPROVED NOV- 118, 1985
EXPIRATION DATE
DATE ISSUED 'L im, 1 RV , 1 qR5
By
Administrative Authority
TELEPHONE: (619) 564-2246
ue repidt:eu uy d ut:enaeu tavn enyu feel ur aui veyul at a M expense ui the perfnrttee. A t:ornpiete set of notes snowing the
ties to these monuments shall be furnished to the City Engineer priorto the removal of any monuments. This office shall
be notified upon completion of replacement of all survey monuments for proper project clearance.