0187 (2)NOTE:_
With proper validation
O
this form constitutes an .• � - ' •
encroachment permit CITY OF•'LA QUINTA U
-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 III
DATE: IKaV 8, 1986 Minor' Improvement Permit Class IV
LOCATION OF CONSTRUCTION Calle Chihuahua
(Street address or,,Description of Location) "
PURPOSE.OF CONSTRUCTION TO install 1931' Of "2" PA med ° Sketch'(attach construction plans if appropriate)
pressure plastic cras main, 121- S/NAL 'of Chihuahua, beginning 10. ' W_/EPL of , Nav'arro, proceeding .west
DESCRIPTION OF CONSTRUCTION ;+
• Gas Co.Work No. 31246-397
DIMENSION OF INSTALLATION -OR REMOVAL
Gas co. Permit No. 180
SIZE OF EXCAVATION,, IF NEEDED ,
APPROXIMATE TIME WHEN WORK W Ma• ..' 86 �,
O ILL BEGIN ,
y c
"
APPROXIMATE TIME OF COMPLETION r7-16=86= ,
ESTIMATED CONSTRUCTION COST $
• '(Including removal of all obstruction, materials, and debris, backfilling, com `
. impaction 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 th e7 Administrative +Authority at least twenty-four (24) hours in advance, of the time `when work will be 11 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. r
/"
Signature of Applicant'or!Agent
Macco Construction P.O. -Box 783 Palm DeSeYt, CA 92260 343-1180 .
Name of Applicant, (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Busin.ess.Address Telephone No
259619 A & B
Contractor's License No. City Business License No. ;
Travelers Ins. -Co. ` TRSLG 173T 795 A 85 '1
Applicant's Insurance Company s Policy Number
FEES: Subdivision Improvement Permit =Class III
Public improvements: 3% of estimated construction costs • r ' , .
- Private improvements: 3% of estimated construction costs
Minor' Improvement Permit - Class IV: See attached schedule t
r
Inspection Fee $ 90.00 PERMIT VALIDATION -
Permit Fee 10.00 187 `
PERMIT NO. _
Penalty May.8, 1986
Cash Deposit -Surety Bond . DATE APPROVED
if required _ EXPIRATION DATE Sept, 1, -1986
TOTA L: � $ • 100.00a
DATE ISSUED ., MeY 8, 1986
Receipt No".
` Received by Date ,i Administrative Authority
Recorded by TELEPHONE: (6191'564-2-246
`12Lr
_ -