0175NOTE:, y
With proper validation
this form.constitutes an
encroachment permit CITY OF LA •.QUINTA
e t' 'APPLICATION1 FOR PERMIT = _
PUBLIC .VVORKS.-.CONSTRUCTION• (ENCROACHMENT)
For the construction of public. or private -curbs, driveways, pavements, sidewalks, -parking lots, sewers;' water mai6s
and'other like public works. improvements in conne'ction•with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS '
'Subdivision Improvement P —
p Permit it Class III _
DATE: March ,10, 1986 Minor Improvement Permit Class IV ,
-LOCATION F 1�_nt of over '
O CONSTRUCTION size: loads thru'.La• Ouistta• f
fOITI East
City . L3mi.ts
West on 48th, -north on Jefferson, west on 44th.out west city limits.
-(Street address or'Description of Location)..r
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION ax10 Mrnntn
1120' ai rt1Prr, 4
DIMENSION•OF INSTALLATION OR REMOVAL v e
•
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN', 3/131f36. or. 3/1-4/86
APPROXIMATE TIME OF COMPLETION ~
ESTIMATE y ,
D N •'.
CO STRUCTION 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: �.
y Indemni•fy,.defend and save the City, its'authprized 'age nts,,officers, .representatives and employees, harmless from'and against any and -all • .
penalties, liabilities or loss resulting from claims or court action and aFising out of any accident, loss or damage to persons or property• }.
happen.ing or„occurring as a proximate result of any work undertaken under the permit granted pursuant to this application: f+
Notify Fthe 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 addition_al.replacement necessary as,the result—of this work.
' Si nature f A I�
�g . o , pp scant or Agent •
HOW Transnoft• 6242 P.afamOubt� LOM Beach, 'CA' , 90801 (213) 422-12.37
Name of,Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No'
Contractor's License No. TM City Business License No. +
'SCA 01-04-80
Applicant's Insurance Companypolicy Number.
FEES: Subdivision Improvement Permit — Class 111 ' ,
Public improvements:. 3% of estimated construction'costs '
Private improvements: 3% of estimated construction costs vµ y i
Minor Improvement Permit'— Class IV: See attached schedule
.Inspection Fee $ PERMIT VALIDATION ,
Permit Fee '60.00 r 17,5
PERMIT NO.
°
Penalty
'” DATE APPROVED 1�+ 3-10-86" '
Cash Deposit -Surety Bond
•r
if required " EXPIRATION DATE 4-1=86 '
I
,{
Y TOTAL: $ FiO_00 DATE ISSUED 3-10-86 ,-
Receipt No. '
+ By' '` r
Received by Date t Yom* Administrative, Authority
i •
Recorded -by • ., '" • � ,
Y TEL'fPHO.NE: (619) 564-2246