0761• Subdivision I9rovement Permit — Class I I I
DATE: .:,�' ._�D Minor Improvement Permit Class IV .,...�...�.��
LOCATION OF CONSTRUCTION 1 krng
�fYYd V•
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 14QMFA - QT1TPMFN1P
DESCRIPTION OF CONSTRUCTION 5'
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HAUL ROUTE:
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com
paction and placing permanent resurfacing and/or replacing Improvements) PILOT CAR REQUIRED
In consideration of the granting of this permit, the applicant hereby agrees to:
indamnlfy,-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 Quints and to pay for any addltlonal replacement necessary as the result of this work,
_6s _
gnature of Applicant or Agent
CATTRAC CONTRUCTIQN INC 15030 SLOVAR FQNTANA&&.92335 714—ISS-114n
Name of Applicant (please print) Business Address Telephone No.
T'
Name of Contractor and Job Foreman Business Address Telephone No.
410347
Contractor's License No.
City Business License No.
_
on file _ on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit -- Class III l00051f3 �A? 124 ! TOTA�L7 130--9& 10.00 SQ
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
n TOTAL:
s as
Receipt No:
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. —44-
DATE APPROVED ,
EXPIRATION DATE
DATE ISS ED
By ;�
7-30 90
0-01-2c
K-30-90
-0 -
-30-90
Administrative
TELEPHONE; (619) 664.2246
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