0284�A
h�IVOTE;
Witih prop°ar validation .
this form constitutes an
encroachment permit `
CITY OF LA QUINTA
APPLICATION FOR PERMIT A.
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 III
DATE: October 26, 1987 _ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Washington Street from 50th Avenue to Fred Warincr• Drive
and,in Sagebrush and Date Palm
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION. Sewer • line construction Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 18" Sewer force main. See project plans .(34 sheets)
on file.
DIMENSION OF INSTALLATION OR REMOVAL 18" trench Note: The attached General and
17 400 feet lona (portion of work in Countv)Special Provisions are
included and made a part
•SIZE�,OF EXCAVATION, IF NEEDED of this permit.
APPROXIMATE TIME WHEN WORK WILL BEGIN October 27 19870
U.S. Inquiry No.
APPROXIMATE TIME OF COMPLETION March 1; 1981A
ESTIMATED CONSTRUCTION COST $ Date:
(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 andemployees, 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
Jones Bros. Construction P: O. Box 905: Coachella. CA 92236 +I
Name of Applicant (please print) Business Address Telephone No.
Don Bente rn
x Same
Name of Contractor and Job Foreman Business Address Telephone No.
17209:!
Contractor's License No. City Business License No.
•
Applican't's Insurance Company Policy Number 4
FEES: Subdivision Improvement Permit — Class I I
# , Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
284
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 590.00 PERMIT VALIDATION
Permit Fee 10.00 PERMIT NO. 7� I
Penalty DATE APPROVED /Z�/� 7
Cash Deposit -Surety Bond 0 / -�
if required EXPIRATION DATE (3 o / �/
TOTAL: $ (;nn. o fl ,
DATE ISSUED /n/7-7 If- 7
Receipt No. s B
Received by Date v Adm in istrativWAuthority
Recorded by TELEPHONE: (619) 564-2246