1593'NOTE: a`
With proper validation
this form constitutes an
i encroachment permit t
CITY• OF LA QUINTA
APPLICATION FOR PERMIT
I
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs ,kdriveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
' 4 Subdivision Improvement Permit — Class I I I
. DATE: 11-3-92 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION NOVe equippenmt r • Sketch (attach construction plans if appropriate)
' Indio Blvd,, to Jefferson, to Fred
DESCRIPTION OF CONSTRUCTION 2 5 T Bac h Waii !
• �µ'� ng, east to White water Flood •,r'
COatrol Channel.
DIMENSION�QF:MTALLA ION OR REMOVAL-LoBded-On 9 axels
.LQ8b � w
wide, 1Sg83..14ngth, LQG14Q rose wt.
i+a 10 1�1D9 ID��y F .
..SIZE OF EXCAVATION, IF NEEDED,
APPROXIMATE TIME,WHEN WORK WILL BEGIN'i-�tµ�Jl '
' 'APPROXIMATE TIME OF COMPLETION11-4.92
"
'i ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials; and debris, backfilling, com-
paction and, placing. permanent resurfacing and/or replacing improvements) '
In consideration,ofithe granting of this permit, the applicant hereby agrees to:. --
Indemnify, -defend
o:•-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
l happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
!I rt-
j 4 Notify the Administrative Authority at least twenty}four (24) hoursinadvance of the time when work will be started.
i 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. '
s ' ,iSignature of Applicant of Agent
Yeager Construction Co+, P .0. Bog 87 Riverside Cal foinia (800) 222-5360
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job"Foreman Business Address ' Telephone No.
Contractor's License No.'.; - City Business License No.
Atnptie4n International BE 7702162
Applicant's Insurance Company 'Policy Number
FEES: Subdivision Improvement Permit — Class III .,.. " g
Public improvements: 3% of estimated construction costs - A"0 LTL 3-92 40•Qi� io
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee w
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 19T00
10.00
$ 10.00
Date
•.t PERMIT VALIDATION
PERMIT NO. 1593
DATE'APPROVED i{/-3-92
•11-4-92
EXPIRATION DATE
DATE ISSUED 1,1-3=92
By
• dministrative Authority
TELEPHONE: (619) 564-2246