1635NOTE:,
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
Subdivision Improvement Permit — Class II I
DATE: December 21r 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
Move aquip1 Ilt p ppropriate)
PURPOSE OF CONSTRUCTION Sketch (attach construction fans if a
DESCRIPTION OF CONSTRUCTION - 623 Sotapeeto 15' htgbi, Haul Route! Taspi''co and Washington
11'10" Wide, 120.000 118 north nut of City LWto
DIMENSION OF INSTALLATION OR REMOVA
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL"BEGI
Haul Date.*
i
APPROXIMATE TIME OF COMPLETION t
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstructionr, materials, and dt�lbris, backfilling, com
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the appl'i.caant hereby agrees tq:
Indemnify, -defend and save the City, its authorized agents, officers, representatives andemployees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court actioned arising .o-�`6f any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertakeh.0 dd the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hour in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and condi ions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as h-resu.lI of this work.
Gat Trno Construction Company
Name of Applicant (please print)
$aplEt
Signature of Applicant or Agent
A.O. sox 2069 Upland, CA 91785
Business Address
Name of Contractor and Job Foreman Business Address
Contractor's License No. �^
-1146
Telephone No. _ ,
Telephone No.
City Business License No.
Applicant's Insurance Company Policy Nu�iir ber
N
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attachedschhe"ddule
Inspection Fee $ -�
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
1635
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246