0199 (2)NOTE:-
"
With proper validation
this form constitutes an
encroachment permit
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:'
June 4, 1986
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
Calle Ensenada from Avenida Bermudas to Avenida Obregon
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Domestic water line improv;
DESCRIPTION OF CONSTRUCTION 1211w3` ter line
DIMENSION OF INSTALLATION OR REMOVAL
See CM drawing
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN June 6, 198
APPROXIMATE TIME OF COMPLETION July 30, 86
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:
Sketch (attach constructionlans if a +
p ppropriate)
Permit is for installation and maint. of
2900 feet of 12 inch water line and
appurtenant work. The attached
general and special provisions are
included and made a part of this
permit.
SEE Encroachment Permit # 188.
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 o k will be started.
Comply with all applicable City Ordinances, the terms' and conditions of the permit and all applica 1e rules and regulations of -the City of
La Quinta and to pay for any additional replacement necessary as the result of this" -work. ,
Signature of Applicant or Agent
Massev Sand and Rock Co. 43-850 Monroe Street Indio 347-8535
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 I II
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 300.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 310.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 199
DATE APPROVED 6-4-86
EXPIRATION DATE 8-30-86
6-4-86
DATE ISSUED j
By
Administrative Authority
TELEPHONE: (619) 564-2246