0253NOTE:-- #"
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
f .
' Subdivision Improvement Permit — Class II I
DATE: February 24, 1987 Minor Improvement 'Permit Class IV
LOCATION OF CONSTRUCTION Jefferscm Street - 48th Avenue to South; of Hicxhway 111
(Street address or Description of Location),
PURPOSE OF CONSTRUCTION Bestrine traffic lines
DESGRIPTION OF CONSTRUCTION TO 12217Vide left turn
_pockdt for local access.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
See attached map.
Work to be per attached plan and
City°s.2/4/87 letter of authorization
(attached)
APPROXIMATE TIME WHEN WORK WILL BEGIN 2/23/87
APPROXIMATE TIME.OF COMPLETION 4/23/87
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.
"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
Citv of Indio 10.0 Civic Center Niall, Indio, CA 92201 347-2351
Name of Applicant (please print) Business Address Telephone No.
,Y Eldon Lee, Director of Public Works
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 v °
Inspection Fee
' Permit Fee'
Penalty _
�,Casli Deposit -Surety Bond
if.required _
TOTAL: $ N/A
Receipt No.
Received by Date
- Recorded by
PERMIT VALIDATION
PERMIT NO. 253
DATE APPROVED 2/24/87
EXPIRATION DATE 3/24/87
DATEIISS�S&ED T/,2.4/87 /I
By��y
Administrative Authority.: .
TELEPHONE: (619)564-2246