0585._..`W
:s +
NOTE:
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
DATE: April 17; 1990
LOCATION OF CONSTRUCTION — 52,Sf;9; jiiarP7.
Subdivision Improvement Permit — Class I I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION electric power Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION excavate approx. 1851f
from proposed pp along, under and along Montezuma
installing 4" cond
DIMENSION OF INSTALLATION OR REMOVAL a ''-`-nch
18" wide, 30" deep, approx. 1 onq .,
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN April 19, 1990
APPROXIMATE TIME OF COMPLETION April '19 , 1990
ESTIMATED CONSTRUCTION COST $ 34()o
()o
(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:
r '
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
y 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 Ouinta and to pay for any additional replacement necessary as the result of this work.
�l A "Al
Sjgnature of Applicant or Agent
Jim Richert 50-305 Hwy 111 Coachella, CA 398-5544
Name of Applicant (please print) Business Address Telephone No.
Dateland Construction Bo. 50-305 Hwy,lll Coachella, CA 92236 39875544
Name of Contractor and Job Foreman Business Address Telephone No.
312854 31
Contractor's License No. City Business License No.
Nationwide Ins. Co 738A003039-001
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
,Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
Received by
in_nn
$ 45.00
Date
inspection 1_day/$35.00
11°o00s�%,as �r�c`rAL 1 9-90 45. 04
to
PERMIT VALIDATION
PERMIT NO. 0585
DATE APPROVED 4/17/90
EXPIRATION DATE 7/17/90
DATE ISSUED ,, 4/17/90
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE':
With proper validation 2.n
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 II I
DATE: April 17 . 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION electric power Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION excavate approx. 1851f
from proposed pp'alonq, under and along Montezuma
DIMENSION OF INSTALLATION OR REMOVALte—a trench
18" wide, 30" deep, approx. 1 T` Ong
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN April 19, 1990
APPROXIMATE TIME OF COMPLETION April 19, 1990
ESTIMATED CONSTRUCTION COST $ i , nnn -
(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. ti
Signature of.Applicant or Agent
Jim Richert 50-305 Hwy 11.1 Coachella, CA 398-5544
Name of Applicant (please print) Business. Address Telephone No.
Dateland Construction Bo. 50-305 Hwy 111 Coachella, CA 92236•' 398-5544
Name of Contractor and Job Foreman Business Address Telephone No.
312854 31
Contractor's License No. City Business License No.
Nationwide Ins. Co 73SA003039-001
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
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
35.00
10.00
$ 45.00 ••
Receipt No.
r.'
Received by Date
$
inspection 1 day/$35.00
4
N'"mi Ca TC1iAL 1 9� 90 45„ 00 io
PERMIT VALIDATION
PERMIT NO. 0585
DATE APPROVED 4/17/90
EXPIRATION DATE 7/17/90
4/17/90
DATE ISSUED
Administrative'Authority
Recorded by 11 TELEPHONE: (619) 564-2246
The following General and Special Provisions are attached to and made a part -of Permit No. J
PROVISIONS',•
t The following shall always apply: a
ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quinta right of way
ONLY. Whenever construction extends within private property, it shall be the responsibility of the permittee (or his contractors) to
+- secure permission from abutting property owners.rSuch authorization must be secured by the permittee prior to starting work.
TRACKLAYINGPCONSTRUCTIOIVEQUIPMENT:% Cleated tracklaying construction equipment shall not be permitted to operate on any.,
paved surface unless fitted with smooth -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect
the paving durin excavations. Rubber-tired,e ui ment only shall be used in backfill operations in paved areas. If the existing
-, P 9 9' q P Y P. P 9
pavement is scarred, spalled, or broken during the term of this contract, or if the pavement is marred, City of La Quinta shall request
that these portions of road be resurfaced over their entire width�Resurfacing shall consist of one coat of two in (2.') of A:C.
"surfacing plus appropriate seal. coat as specified above.
PROTECTION OF TRAFFIC: All excavationsand work areas shall be properly lighted and barricaded as deemed necessary by the City '
EngineerorCaQuintaCityPublic Works lnspectors:Suitabledetours and detour signs shall beplaced and maintained for the duration
of the project.,The City shall be notified 24 Hrs. in advance of any traffic'detours or. delineations. '
CARE OF DRAINAGE STRUCTURES: Any drainage structure including corrugated metal pipe, concrete pipe, steel culvert and
° concrete structures encountered during excavation which necessitate removal shall be replaced in kind. In the event -it becomes
necessary to remove or cut existing drainage stru&ures,`City of La Quinta shall be notified prior to commencement of this work.
Drainage structures and open drains shall be kept free of debris at.all times for proper drainage. +
K
r RIGHT OF WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right of
way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately afte.rbackfill and compaction.
' Existing gutter line and drainage ditches shall be replaced to their original siandard or better. All excess material shall be removed
prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used
immediately after backfill. "
' A ,*.DE -WATER OPERATIONS: If de -watering operatio s are required and pumps are forcing wateron City of La Quinta roads, it shall be
7-- the responsibility of the permittee (contractor) to control this water and to provide off-street barricades when necessary.
CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited .
access for the adjoining property owners and emergency vehicles. In the event it isfelt bythe permitteethat he mustclose a street for
any length of time, permittee shall contact this office to obtain the necessary permission. ,
' - * SPECIAL PROVISIONS` `
' , a The follwing shall apply ONLY when indicated:
tl, y r1,NOTIFICATION: Permittee shall notify the City at 564-2246 at least 48 hours in advance of starting construction..
r R2 CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amount of not less than s
• l— . s• shall be furnished in the name of Ci[y of La Quinta to cover all work involved inthe restoration of the various Le Quinta ..
roads and survey, monuments. This bond shall be continuous until cancelled by the City Engineer. This bond must be,
j posted prior to commencement of any work on this project .
R3 UTILITY CLEARANCE: (Substructures) Prior to making any excavationwithintheCity,ofLaQuinta right ofway authorized
by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures.
Damage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility
^ of the permittee. z
R4 UTILITY CLEARANCE: (Surface structures) No work'shall be done under this permit until all utilities are clear of the
proposed work site. The -permittee shall notify all concerned utility companies of the proposed work. -
" R5 PAVEMENT,WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be
# .surfaced with inches of A.C. paving placed on . - inches of class aggregate subbase course '
having an"R" value of not less than • and in conformance with City of La Quinta Road Improvement Standards
F and Specifications; Ordinance tt461. + i
' R6 PARKWAY GRADING: Area between the property lirie anditop of the proposed concrete curbshall be gradedtL a slope of
1/4 inch to one foot (11. •.,_ K
�^ +R7GRADES! & STAKES: City of La Quinta shall establish grades and stakes for the proposed concrete curb and gutter
construction. y `
• (RS ,GRADE CHECKING: City of La Quinta shall checkgrades i"on receipt of plan and pFofile and/or grades as established by
alicensed engineer: r. `
r e ? YR9 . CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter( ' feet)shall be. +
- removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and
` `!concrete driveway approach shall be constructed in conformance with City of La Quinta Standard #207.
:c t : *R10 DRIVEWAYS, A.C.: Driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the
property line and the existing road paving shall be 2-1/2 inches of A.C. paving placed on ( ") of class
r a+ • aggregate base: Driveway construction shall conform to attached drawing:
R11 CULVERTS: A inch diameter( )culvert shall be installed with the invert approximately 1-1/2
inches below and in line with the existing flow line. Culvert installation shall conform to the attached drawing.
t( R12' SIGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained.
R13 SOIL STERILIZER: The area to be surfaced shall be Treated with soil sterilizer. Rate of application shall complywith the
manufacturer's specifications.
1 , COORDINATE WORK: The proposed work shall be subordinated to any operation which the State of California or
City of La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or -
' City of La Quinta forces to preclude delay or interference with State or City of La Quinta projects.'
r 15,. SURVEY MONUMENTS: Prior to excavation or. beginning of construction, all survey monuments which exist on the
t • e • "centerline of all streets or property lines when involved shall be completely tied out so they maybe readily and correctly
5 , be replaced by.a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the ._
ties to these monuments shall be furnished to the City Engineer prior tothe removal of any monuments. Thisoffice shall
be notified upon completion of replacement of all survey monuments for proper project clearance.
w
R16 (EY MONUMENTS: Prior to excavation or beginning of co ;tion, all survey monuments shall be tied out by City
Quinta and suitable payment or guarantee of payment„o„ be made as reimbursement for all work involved.
R17 PAVEMENT CUTTING: Pavement will be mechanically cut to a straight edge prior to excavation. Method of pavement
cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment
be used to excavate prior to cutting of pavement). Excavation material shall be placed in such a position as to best
facilitate the general flow of traffic. Prior to final paving operations, any damage to pavement straight edge shall be
corrected.
R18 PAVEMENT CUTTING: Pavement shall be saw cut prior to removal. Prior to final paving operations, any damage to
pavement straight edge shall be corrected.
LIMIT OF EXCAVATIONS: Excavations shall be
19 t
begin. All excavations shall be properly barricaded with lights overnight, oh weekends and holidays for the protection of
the traveling public. The Public Works inspector shall determine the suitability of excavation barricading in each case. No
excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the construction
material is actually on the work site.
( ZO BACKFILL MATERIAL: Backfill shall be free of brush, roots or otherorganic substance detrimentalto its use for purposes
\_ of producing an adequately consolidated backfill. Any material which the City of La Quinta deems unsuitable (spongy or
saturated material) which is encountered during excavation shall not be used for backfill, but shall be supplemented or
replaced by an approved sand or gravel.
R21 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed in lifts of notgreaterthan
three feet (3') and vibrated using vibrotamper or equivalent equipment. Alternate methods maybe substituted, but in any
case a relative compaction of 95 percent shall be attained within the structural section of the roadway.
R22 BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than 50 percent of the total depth of the trench
before flooding or a maximum of five-foot (5') liftswhere trenches are of excessive depths. Care is to be exercised that the
backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the
resulting compaction shall be not less than 90percentor equivalenttothe surrounding ground, whichever isthe greater
compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain
the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water
supply shall be continuous.
R23 COMPACTION TESTS: If so required bythe inspector, compaction tests shall be made at intervals of not more than 1,000
feet and a minimum of one (1) test on each road. One (1) copy of each test shall be forwarded to the City Engineer for
approval andfiled prior to making permanent repairs. Compaction testsshall be made as outlined in Section 6.3.01 of the
Standard Specifications, Division of Highways, State of California, dated January 1973.
�`ne
24 OMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
(1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs.
Compaction tests shall be made asoutlined in Section 6.3.01 ofthe Standard Specifications, Division of Highways, State
of California, dated January 1973.
R25) TEMPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch
consisting of 2 inches of SC -800 shall be placed on a prepared subgrade. The SC -800 temporary paving shall be placed
after a maximum of 3,000 lineal feet -)f trench has beer. excavated and backfill operations completed, but in no case shall
the placement of the temporary pavement exceed a five (5) day limit.
R26 PERMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch
consisting of two inches (2") of SC -800 shall be placed immediately. A permanent patch of inches A.C.
surfacing placed on a inch class base shall be placed no later than days after completion of
temporary road repair.
R27 PAVEMENT REPAIR: F.A.S.: Upon completion of backfill and compaction, a temporary patch consisting of two inches (2")
of cold mix paving (SC -800) shall be placed immediately. A permanent patch of three inches (3") of A.C, surfacing shall
be placed on six inches (6") concrete base as directed, but not later than fifteen (15) days after completion of temporary
paving. Concrete base shall beef five -sack mix and shall conform to the City of La Quinta Road Improvement Standards
and Specifications, Ordinance #461.
R28 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as
determined by the City Engineer.
R29 SEAL ARMOR COAT: A seal coat consisting of an application binder and screenings shall be applied on all patch areas
where such seal coats existed prior to issuance of this permit. Seal or armor coats shall be applied as specified in Section
37, Standard Specifications, State of California, Division of Highways, dated January 1973. Work of pavement repair to
be accomplished by a licensed contractor engaged in the business of pavement repair.
R30 STREET RESTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
R31 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right of way shall be accomplished
by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public.
It shall be the responsibility of the permittee to maintain the tree in a vigorous growing condition at its new location.
Trees to be removed shall be removed in sections which can be handled safely without interference or hazard to highway
traffic. The entire width of the tree stump shall be removed and disposed of so that no debris remains in view of the
highway. The stump hole shall be backfilled and thoroughly compacted as specified in the following paragraph. Where it
becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500 feet at any one time. Adequate
signs, flagmen and/or barricades shall be provided to protect the traveling public at all times.
Large holes resulting from tree removal shall be backfilled and compacted to not less than 90 percent or equivalent to the
surrounding ground, whichever is the greater compaction as determined by the impact or field method. Compaction
tests shall comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated
January 1973.
R32 TREE TRIMMING:
a. Only the necessary trimming shall be accomplished to provide clearance of the facility for one calendar year.
All broken or weak sections within the trimming shall be removed.
b. Where it becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500 feet at anyonetime.
Adequate signs, flagmen, and/or barricades shall be provided to protect the traveling public at all times.
c. If tree trunks are partially outside of the City of La Quinta road right of way, permittee shall make his own
arrangements with adjoining property owners for consent to the trimming in addition to the authorization provided
by this permit.
d. All tree trimming on EVERGREEN TREES, PALM TREES, and other ORNAMENTAL TREES shall be accomplished to
the satisfaction of the City Public Works Inspector.
e. Abutting property owners shall be contacted, in all instances, prior to trimming or topping trees.
f. Pruning shall, in all instances, be at the shoulder of the crotch to insure even, fast healing in all cuts of two inches
(2") and above in size. Sealant shall be applied to all cut sections as directed by the City Public Works Inspector.
ADDITION NCROACHMENT:PERMLT NO 05 '�--- CONDITIONS"
•R33`
'Survey 'monuments , shall •be ' protected ins place; or
-
re-established pursuant to.City standards and the. State of
`
California -•Land.- Surveyors`Act.
R34
-Work shall* be ``coordinated •-with the City ' of "L•a Quin'ta s.
'..,,forces-to
preclude-delay, or interference :with" the• City• of La
_„ ects ;
R35',"
Contractor shall•comply:with the .local noise ordinanceand
'
construction operations-and maintenance- of,equipme.nt within.
one'-half. mile., of.. human occupancy 'shall be ,performed only
during the -tie' .periods'' as, follows: � �
October 1st.to•°April- 30:,,�Monday-Friday 7:00a.:mR-5:30p.m.
Saturday- , -..•8 OOa.m. -5: OOp.m.
May --lst.^to"-September 30i _Monday-Friday 6: 00a.m.-7,:'00p.m.
Saturday . '8". OOa.m.-'5.00§'m.
r
1
ederal-
,Work shallbe.prohibited'anytime on.Sunday"-and`-Federal-
,,.holiday'.
,holiday'.
,.'R36
Traffic';control. shall- be. as per Cal. Trans. Traffic Manual.
Field`ad:j ustments.inKdetouring shall be accomplished as.
r Tx
.
directed-* in order .:to _adjust to actual .field `conditions. It-
shall',be the contractor's°responsibility .to, '. adequately, ;
-
barricade and detour. this �: site . A •Traffic, control plan shall • `:
-
be submitted f or - approval. by the -City Engineer .' -
R37
All excavation at or,.near the travel.way-shall be'backfilled
at the to nd of t:ie work'day; forthe protection �•of_ the.,
-traveling public;I*.
: R38
Street: closures shall not; be .allowed'. at '. any time.,
R39-.,
A minimum,-of one � travel larie•'shall be maintained at,all
times with ,flagmen during working,hours:.f _
R40
All•work to be performed within:the•_existing paved section
_.
shall be, temporary.paved.,and maintained-'by the;Permittee,.
permanent-,pavement shall" be placed no. later.: than 1`5'- days -.
{ R
LJ
after completion' of the temporary,•road-.repair,
•' •'� • ,
.
R4f
y' art • 4 'E ;' . '' * 1 .. '
°"Ingress and egress for local--properties shallbe maintained
-
at:all'times.
- R4'2
Prior to, work-starting,.Underground Service 'Alert shall be'.
contacted' at 1=800-°422:-4133 and ' ari 'L "inquiryX number"shall -` be .
providedto.;the City*Public Works Inspector.
R43
Pavement *shall be-sawcut. p.rior'"'to removal',.
60�
8160
DATELAND CONSTRUCTION CO. CHECK
s
NOTE:
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, watir mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit —Class III .__--
DATE: 7 / 7 / Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION _ 15-6D 5 `1 ► ?
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRICTION (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 111
DATE: — U �� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
"�-
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION FIJLJ k2 Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
U .7_ P 6fW4,6 Li Kit i 6 I Cwy
DIMENSION OF INSTALLATION OR REMOVAL
0111,, 11,
SIZE OF EXCAVATION, IF NEEDED ;
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION LT 17
ESTIMATED CONSTRUCTION COST $
0ncludinn rernct!-e� of
li�_ Lam.
\I YM\IVI1, li�atcrla , and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) �Z y " `� `� Z ' 0 2 z
In consideration of the gran!inr of this permit, the ap::!; zn; h.6Eby 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 It ofthis wor
r
v
Signature of Applicant or Agent
Name of Applicant (please print) Business Address Telephone No.
Name of. Contractor and Job Foreman Business Address Telephone No.
7l ib7� l(
75
Contractor's License No. h 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. N0
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ II. PERMIT'VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
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