0938 (2)Ab • , ' ' • +'iill�i ••�- »��i,l �.��•�•—• —_.,
NOTE: - c.
With proper ve4de o n
this form constitutes an r CITY, O F • LA" QUINTA% • `
entxoachment•permit ;
APPLICATION; FOR' PERMIT' y
PUBLIC WORKS' CONSTRUCTION , (ENCROACHMENT) _
For the, construction: of public or private curbs: driveways, zpavements, 'sidewaiks, parking lots, sewers; watw, mairw,
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
' Subdivision Improvement Permit - Class III
OATE: Minor •improvement'Permit Class IV
LOCATION OF CONSTRUCTION -may L0 dn"' e i. Q '
(Street adormlor Oesertpdon of Loeationl•,., -
PURPOSE OF CONSTRUCTION: - i,v r 4' �'` ` A� t7+�a►ac�y Sketchlattach-construction-pians it applrpprWtijY
DESCRIPTION OF CONSTRUCTION" s T•�.M, `
-DIMENSIONOF INSTALLATION OR'REMOVAL a x
SIZE OF EXCAVATION, IF NEEDED' ,
APPROXIMATE TIME WHEN -WORK WILL BEGIN /4_ 2.2 " 90
APPROXIMATE TIME OF COMPLETION 19 —`9,
ESTIMATED CONSTRUCTION COST $
' (Including removal of all obstruetion,�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:
Indemnity, defend and saw the City, its authorized agents*officers,-representatives and emoloyees,iharmless from and against any and an
penalties. liabilities or lo-resuiting from cfaimi or court action and arising out of any accident, loss or damage^to persons or ptapartv•y
happening or occurring as a proximate result of any, wc":undertaken .under• the permit, granted pursuint to this application.
Notify the Administrative Authority, at least twenty-four 124) hours in advance of the time when work will be started.
Comoly with all, applicable City Ordinances; the terms and conditions of the permit and ail applicable rules, and regulations of the City of
La Quints and to pay for srry additional reciaosmarit necessary as thei UA rk.
Sig re of
'Applicant or Agent
%1/nlc� (9 CJh
Pk Ai 7-/ /cPea2 r /moo a e,. i �► o l 7A � i��,<{� (. 3 Ll
Name of Applicant -(please orintl. Business Address Telephone No-.
s0IR U i2 /0�9�. N ua eX�C• X' 7 _� / Z i SO N e .f [ 3'-I 6- '-t I'�
Name of Contractor and Ab Foreman Business Address • Telephone No. ^
ZS"2211
Contractor's License No. City Business License No.
eV3 0 S- RG
Applicant's Insurance Company.: Policy Number
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Imorovement Permit— Class IV: See attached schedule
insoectfon Fee S PERMIT VALIDATION
_ r
Permit Fee
PERMIT NO.
Penalty
Cash Deposit -Surety Bond DATE `APPROVED � ` = v � • ,
if required •`, EXPIRATION DATE
TOTAL: $ I DATE ISSUED '
Receipt No. - ,, • •
By
Received by Date } ° Administrative Authority
Recorded by TELEPHONE: (619) 664.2246 '