0230NOTE: f
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
Subdivision Improvement.Permit — Class I I I
DATE: October 31, 1986 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION See Pernut # 227
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION See permit # 227 Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION'
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Original permit #•227 issued to G.T.E.
bEw attached Special and General Provision:
are attached and, made a part of this permit
APPROXIMATE TIME OF COMPLETION
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 permitgranted 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.
Signature of Applicant or Agent
Alex Robertson Gmpany 11015 Bloomfield Ave. Santa Fe Springs, CA 90670 (213), 946-8851
Name of Applicant (please print) Business Address Telephone No.
Ron Watson'
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 III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule N 2.30,
Inspection Fee $ 600.00. (20 days) PERMIT VALIDATION
Permit Fee 10.00 230 .
PERMIT NO.
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 610.00
Receipt No.
Received by Date
Recorded by
DATE APPROVED 10-31-86
EXPIRATION DATE .12-30-86
DATE ISSUED 10-31-86
By
Administrative Authority
TELEPHONE: (619) 564-2246
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