0169With.F lidation
this - for ,titutes an
encroachment permit
A
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
Subdivision Improvement Permit — Class I
DATE: January 21, 1..9815 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION—= ('z.T,E, Buildi—na on La Fonda
(Street address or Description of Location)
ICIoye adrelacPURPOSE OF CONSTRUCTIONSketch (attach, construction plans if appropriate)
dri.v yray a}::ycnoa,L.
DESCRIPTION OF CONSTRUCTION
DIMENSION OF•INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE: TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION WRIER@
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 of this work.
gnature of Applicant or Agent
Jack Morey C.e-ment Qontractors 4721 E. Sumdy DUnes Rd. Palm Springs 320•-6897
Name of Applicant (please print) Business. Address Telephone No.
Jack Morey Sr. ,
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 111^ r 1986
ENTERED JAN
Public improvements: 3% of estimated construction costs ,
Private improvements: 3% of estimated construction costs �jQ
Minor Improvement Permit— Class IV: See attached schedule •" • 1"""'
Inspection Fee $ 20.00 PERMIT, VALIDATION
Plt F II:'
JPenalty •
Cash Deposit -Surety Bond
if required
TOTAL: $ 20.,00
Receip ,No.
Received by, Date
Recorded�.by
PERMIT N0. 169
DATE APPROVED 1-21-86 {.
EXPIRATION DATE 3-21-36 _ r
DATE ISSUED 1-21-96,
u _•
,By'
. Administrative Authority.,,
. TELEPHONE: (619) 5642246 """
161 5%uq) �o T E c m M