0214NOTE:••
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit,
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
8-12-86 1 y
DATE-
,
ATEt' c
LOCATION OF CONSTRUCTION Tk
'acro No. 21120 -N
Subdivision Improvement Permit —Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION- �r0%bd1V1SiOri Im mvenmts Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION On Site i=rbVeMT1tS ,
DIMENSION OF INSTALLATION OR REMOVAL ' PIMS PLANS ON FIIjE _
SIZE OF EXCAVATION, IF NEEDED S&e plans
" APPROXIMATE TIME WHEN WORK,WILL BEGIN 8-13-86
APPROXIMATE TIME OF COMPLETION 8-13-87
ESTIMATED CONSTRUCTION COST $ $242,400.
(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 cr court action and arising out of any accident, loss or damage' to persons or property'
.`fiapOening or occurring as a proximate' result of any work undertaken under the permit granted pursuant to this application..
.:•w.:.ri- - -o -
Notify' the Adminisfrative Authority at least twenty-four (24)• hours .in advance of the time when work will be started.
• .• it
} Comply with all applicable City Ord inances;`the terms and conditions of the permit and all applicable rules and regulations the City
i
y
of of
La Quinta and to pay.for, any, additional. replacement necessary as the result of this work'_.! -
CA <:Y 2
` �S�gnature of Applicant or Agent
AndEm Corporation '77-350 Avenida Fernando La Quinga '564-4315
Name of Applicant (please print) Business Address Telephone No.
TC tl t Hill sart�
,
3
Name of Contractor. and Job Foreman Business Address Telephone,No..
'
333762. 159
'I.. Contractor's License No. ' r City Business License No.
tk
Fi.:remans, Fund Y on file
`'
Applicant's Insurance: Company 'Policy Number
FEES: Subdivision Improvement Permit — Class III -
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs '
Minor Improvement Permit = Class IV: See attached schedule �' 214
Inspedtion Fee $ included PERMIT VALIDATION.
y
.
Permit.Fee. ''
, PERMIT.NO. 214
Penalty,
Cash Deposit Surety Bond ' DATE APPROVED 8-12-86 z.
..
if required A -1-R7
EXPIRATION DATE
'
TOTAL: $ 6,348.80'
r DATE ISSUED
Receipt No.
By
Received by Date Administrative Authority•
Recorded by TELEPHONE: (619) 564-2246 .