1321NOTE:,
.With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
., 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 I I I
DATE: December 31. 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION West side of Monroe St., 1/2 mile south of 54th Ave.
1
(Street address or Description of Location)
Subdivision improvements for ( p ppropriate)
PURPOSE f CONSTRUCTION Sketch, attach construction lans if a
Tract 26769.
DESCRIPTION OF CONSTRUCTION Water and electrical
conduit crossing. Improvements to be constructed per
approved plans and in accordance '
DIMENSION OF INSTALLATION OR REMOVAL with the provisions of Permit No. 1260.
_ See attached -conditions.
SIZE OF EXCAVATION, IF NEEDED `
APPROXIMATE TIME WHEN WORK WILL BEGIN
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) '
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
happeningor 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''.
Pg atu&e15f Applicant or Agent
Qualco Developments, Inc.- 74596 Pepper Tres Dr..Palm'Desert, CA 92260 774-4917
Name of Applicant (please print) Business Address Telephone No. -
QxtnArlRw.i 1 Amr - ,..;4 � •
Name of Contractor and Joli'Foreman } Business Address Telephone No.
Contractor's LicenserNo. City Business License No.
Maryland Caslty Co. 4
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 Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
I'
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
-0-
Received by Date
Recorded by.
PERMIT VALIDATION
PERMIT NO. 1321
DATE APPROVED 12/31/91
EXPIRATION DATE
4/31/92
DATE ISSUED LA91-2
By r
P� ministrative Authority
TELEPHONE: (619) 564-2246 /