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CITY OF LA QUINTA
encroachment permit
„. 'APPLICATION FOR PERMIT
- PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) �• Sww�
• - 0F TI�'9w
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
4
Subdivision Improvement Permit — Class III
DATE: DF -MI -Mb -Ar in, 19F36 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Traci 21381-1
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION SubdiVieion T243CiVF2.iitt is Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
See approved plans.
DIMENSION OF INSTALLATION OR REMOVAL
JILL ur C_AW1VH I IUIV, I.r IVttUtU -
APPROXIMATE TIME WHEN WORK WILL BEGIN `
APPROXIMATE TIME O,F'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 permit granted pursuant to this application.
K' Notify the Administrative Authority, at least twenty-four (24) hours in advance of the time'when work will be started. r
A Comply with all "applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City.•of'
i /
La Quinta and to pay for any additional replacement necessary as the result, of •his work.
t+ ignature of Applicant or Agent r
National Mortgage and.Land 75-005 Country Club Drive Palm D(sert 56872828--
Name
68;2828Name 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 III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs24-5
{
Minor Improvement Permit— Class IV: See attached schedule;.+,' M ° "
Inspection Fee $ 4,547.00 PERMIT VALIDATION
Permit Fee.; �. w 1(1 00
"''r PERMIT NO. 245
Penalty
r Cash Deposit -Surety Bond DATE APPROVED
if required (On File) . ( EXPIRATION DATE
TOTAL:$ 4,5500
DATE ISSUED
Receipt No.
By
Received`by.� DateAdministrative Authority
Recorded by TELEPHONE: (61.9) 564-2246