150341
With proper,validation �� Q
•ths fom aconstitutes an - CITY OF LA QUINTA
encroachment permit t
;f• `tib,. - .r APPLICATION FOR PERMIT
�• .rf{= PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OF THBR
For' the. construction of. public or. private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
W'. 'and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class II I
DATE:^"� $3/92 Minor Improvement Permit Class IV
''.LOCATION OF CONSTRUCTION
.,. (Street address or Description of Location)
E a PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
' DESCRIPTION OF CONSTRUCTION Paver, 1116" wide Haul Route: Eisenhower at Madrid to
84,000 Itis, all else legal Durango to Avenue 52 and City Limits.
:.DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 8/4/92
SIZE1OF,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-
.
pactionaand placing permanent resurfacing and/or replacing improvements)
!,• �., :In4consideration 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.
Notifyfthe 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.
Signature of Applicamaor Agent
` �tC aali to,,Construction P.O. Box 9011 Palm Desert, CA 92255 775-8302
' k �
'h Name of'Applicant'(please print) Business Address Telephone No.
,Narrie;of Contractor and Job Foreman Business Address Telephone No.
.Contractor's License,No, City Business License No.
}Applicant'sansurance Company Policy Number
:c
'~ •' FEES:' ^Subdivision lmprovementyPermit — Class I I I
"' •"i' +,a Public improvements: 3% of estimated construction costs
I� ``•`x "Private improvements: 3% of estimated construction costs
1:
I . , •Minor Impr.overrient Permit — Class IV: See attached schedule1 �03
_.
;,Inspection. Fee $ PERMIT VALIDATION
;), 10.00
Permit Fee - 1503PERMIT N0.
Penalty -,
Cash Deposit -Surety Bond DATE APPROVED 8/3/92
if required EXPIRATION DATE 8/4/92
TOTAL
Receipt. No.
Received by
Recorded by
Date
DATE ISSUED 1 --8/3/92
Administrative Authority
TELEPHONE: (619) 564-2246
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