15390
Mr
Willi proper validation. !
this form constitutes an
encroachment permit j
N
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 with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit— Class III
DATE: septtlRbit 10, 1992" Minor Improvement Permit Class IV
'101S Westward Ho Dr. W/O Dun. PA10A Road
LOCATION OF CONSTRUCTIO!
(Street address or Description of L6cati4,
PURPOSE OF CONSTRUCTION ,Relocation. of aerial plant Sketch (attach construction plans if appropriate)
due to street iuprovaaaftr. a
DESCRIPTION OF CONSTRUCTION BukT 1275 feet of ttle»hona
cable K.O. Y mlber 0349-SP601AU
l�
DIMENSION OF. INSTALLATION OR,REMCIVAL Be* Attached Drawing.
•
So* Attached Conditions.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEG)Nw 9/22/92 ,
APPROXIMATE TIME OF COMPLETION 12/30/92
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris", 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 and regulations of the City of
La Quinta and to pay for, any additional replacement necessary as the*result of this work. F
��Aj
Signature of Applicant or Agent
GTP: California Inc. ' SMS—S4i� ,Jaakrean St. , 'Indio, CA 042-0621
Name of Applicant (please print) Business Addressk Telephone No.
Name of Contractor and Job Foreman } Business Address Telephone No.
Contractor's License No. ► City Business License No.
Applicant's Insurance Company Policy Number
FEES: •Subdivision Improvement Permit — Class I II
Public improvements: 31/o of estimated construction costs
Private improvements: 3%of•estimated construction costs.
'Minor Improvement Permit — Class IV: See attached schedule 1539
Inspection Fee $ "�" II PERMIT VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ —0—
Receipt
0-
Receipt No.
Received by
Recorded by
Date
v
PERMIT NO. 1539
DATE APPROVED 9/10/92
EXPIRATION DATE 12/30/92
DATE ISSUED 9/10/92
By ANS
Administrative Authority
TELEPHONE: (619) 564-2246
�.�` Q lJ!