1381NOTE:,,
With proper"validation
t. th,!Ho* rm constitutes an
_—encroachment permit
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3
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 witli'MINOR IMPROVEMENT,$,and.APPROVED SUBDIVISIONS
DATE:_- March 12. 1992
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equfpment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION D-7 Dozer, 12 VW x 1316" A Hau1 Date: 3/12/92
Q4,()M 1bA
Haul Route: Monroe & 50 to Park to
DIMENSION OF INSTALLATION OR REMOVAL Bighorn St (Brock Homes)
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION p i
82 10
ESTIMATED CONSTRUCTION COST $ 0 IV, C_SHS3i2 0InL 192 10.0U'`
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) 1
In consideration of the granting of this permit, the applicant hereby agrees to: t
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 forlany additional replacement, necessary as the result of this wo
w w
S'g t re f Applicant OKgent .
R.J.Stowells Jr. P.O: Box 1059 Indio, CA 92201 774-1359
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address
PUC #1059
Contracto'r's License No.,
Telephone No.
On File
City Business License No.
Cal Farm On File
e,
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs "
Private improvements: 3% of estimated construction costs 138 1
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
10.00
$ 10.00
Date
PERMIT VALIDATION
PERMIT NO. 13$1
DATE APPROVED 3/12/92
EXPIRATION DATE
3/12/92
DATE ISSUED 3/12/92
By
Administrative Authority
TELEPHONE: (619) 564-2246