15951
NOTE:
-.With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOUR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
i
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
i
Subdivision Improvement Permit— Class III
DATE: November S, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-920 Avenida Monyretuma
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Drive Approaeh
DESCRIPTION OF CONSTRUCTION '
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
-Ft. ,
SIZE OF EXCAVATION, IF NEEDED
t
APPROXIMATE TIME WHEN WORK WILL BEGIN 11-5-92
APPROXIMATE TIME OF COMPLETION 1114-92
ESTIMATED CONSTRUCTION COST $ 5500 r
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
r
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.
r
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
t
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 oytnis work.
//Signature of Appl•ant'or AgenX
Stuart Podell P.O. Box 76 La Quinta>:, C, Ifornia 92253 8-6014
Name of Applicant (please print) Business Address Telephone No.
JMK Davleopment 11.684 Ventura Id. Los Angeles, California 213-656-x3153
Name of Contractor and Job Foreman
590684
Business Address
2557
Telephone No.
Contractor's License No. City Business License No. {
Farvers 1 ONBILE ON BILE
Applicant's Insurance Company Policy Number
FEES: Subdivision -improvement Permit — Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20.00
Permit Fee j6111 10.00
Penalty "-
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 30.00
Received by Date
Recorded by
i
?85"IFAIR PTVATA�-25,92 30.00 i0
15,95
PERMIT VALIDATION
PERMIT NO. 1595
DATE APPROVED
11-5-92
EXPIRATION DATE 11-X14-92
DATE ISSUED \1 1-5-92
By
% Administrative Authority
TELEPHONE: (619) 564-2246