1440-------------------------------------------------------------------------------------------------- 4,--1
• J ,
NOTE:
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
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May 18 , 1992
DATE:. Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION End of cul-de-sac on Via Ravenna at Lake La Quints, Tract 26152
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION TmgrnvotnPnt of sarnrm drain Sketch (attach construction plans if appropriate)
system, by routing of underground.
DESCRIPTION OF CONSTRUCTION • Addition of match hasin 1. No work is permitted within paved
and 18" P.V.C. vine. section.
DIMENSION OF INSTALLATION OR REMOVAL _Approximately 120 2. Construct per approved Storm Drain
Pf 18" P.V.C. line. plan.•
SIZE OF EXCAVATION, IF NEEDED 2" wide X 1201 long
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/19/92
APPROXIMATE TIME OF COMPLETION6/19/92
ESTIMATED CONSTRUCTION COST $ 3.500.00
(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
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 an, regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of his work.
Sign' ture of scant o Agent
a Pacific 2801 Townsgate, Suite 211 Westlake Village, CA 91361 (805(9495
of Applicant (please print) Business Address Telephone No.
erside Pipeline Bill Shulte 3131 Van Buren Riverside, CA 92503 (714) 359-1220
of Contractor and Job Foreman Business Address Telephone No.
458787 .1730.
Contractor's License No. City Business License No.
Wilm
-501
Name
Riv
Name
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit - Class 111 00?P2 C 11?8T8T-11AL 1 S05.00
Public improvements: 3% of estimated construction costs //� I n
Private improvements: 3%'of estimated construction -costs y -4Q ,
Minor Improvement Permit - Class IV: See attached schedule
Inspection Fee $ 105.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 105.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1440
DATEAPPROVED 5/18/92
EXPIRATION DATE 6/19/92
DATE ISSUED 5/18/92
By
Administrative Authority
TELEPHONE: (619) 564-2246