0715 (2)Alt
NOTE: ,
r
With proper validation -" - -
'
this form constitutes an CITY OF LA QUINTA
encroachment permit v
APPLICATION FOR tPERMIT
PUBLICWORKS CONSTRUCTION- (ENCROACHMENT)`,
For the construction of 'public or private curbs, driveways, pavements, sidewalks; parking lots ,• sewers; ,water•mai'nsx
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS. ,
• Subdivision Improvement Permit—Class III
DATE: Minor Improvement Permit Class IV,
LOCATION OF CONSTRUCTION 79 999. Av n i - 52, La• Qui n• a and East nid' of ' Sod Farm
r �q1-01,e l?T .SAS%~ r �7 9 4'T a .4 Pe.' S-2 . X11 OfJ/.L��E1
(Street addressor Description of Location).
/,�k IG,s=�-
PURPOSE OF CONSTRUCTION' To citrus trees Sketch (attach construction` plans if.appiopriate)
on both sides of Ave. 52; temporarily
DESCRIPTION OF CONSTRUCTION%- 10" PVC irrigation .
line, crossing Ave. 52.
DIMENSION OF INSTALLATION OR REMOVAL '
.SIZE OF EXCAVATION, IF NEEDED r
APPROXIMATE TIME WHEN WORK WILL BEGIN ASAP • ,
. z
APPROXIMATE TIME OF COMPLETION 6/25/•90
ESTIMATED CONSTRUCTION COST S 2-,500.,00
-(Including removal of all obsfftaction; materials, and debris, 5adkfilling, com-
paction
om 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-empioyees, harmless fiam 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'perrnit 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 theresult of this work
r - Signatur of Applican or gent '
Landmark Land Company P.O. Box 1000, La'Quinta 345 -2888 -
Name of Applicant (please print) A Business Address Telephone No.
CVPipe and Grading/ Ken Long - Landmark 774-1292
Name of Contractor and Job Foreman Business Address F Telephone No.
-551449 f On file
Contractor's License No. City Business License No. --
The Travelers 197T112889 and Workers Comp WC 807412465 '
-� Applicant's Insurance Company _ Policy Number
FEES: Subdivision Improvement Permit -Class Ill r .
L t; Public improvements: `396 of estimated construction costs-' -
'' . •, Private improvements: 3% of estimated construction costs - U
Minor Improvement Permit - Class IV: See attached schedule s
'Inspection Fee $ Zo PERMIT VALIDATION
Permit Fee ! 4. PERMIT -NO.
Penalty _ 'DATE APPROVED
'Cash Deposit -Surety Bond ' _
if required. EXPIRATION DATE
TOTAL: $' DATE ISSUED
Receipt No.
Received byDate t Administrative. Authority
Recorded by f TELEPHONE: (619) 564-2246 ,�