1644NOTE':
With proper validation
this form constitutes an
encroachment permit
For the constructiA7
and other like public
g
O�AQIJIINTA
PPLIC ON FORPERMIT
PUBLIG,"WOR CONSTRUCTION (ENCROACHMENT)
of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
orks Improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit— Class III
DATE: 1-5-93 Minor Improvement Permit Class IV
LOCATION OF -CONSTRUCTION Washington St. s/o Hwy. 1.11 to' Simon Drive
(Street addressor Description of Location) ,
PURPOSE OF CONSTRUCTION 0^41-16n1w to 1nnAtA apt -114 tion Sketch (attach construction plans if appropriate)
a I
DESCRIPTION OF CONSTRUCTION Vacuum soil extraction See drawing showing proposed
to expose utilities pothole locations
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 10" to 12" hole
APPROXIMATE TIME WHEN WOWWILL BEGIN 1-11-93
9:00 AM after traffic subsides
APPROXIMATE TIME OF COMPLETION 2 days
ESTIMATED CONSTRUCTION COST $ 4345
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
See attached conditdnas
i -
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.
Signature of Applicant or Agent
SOFTDIG UNDERGROUND SERVICES, IN P.O. BOIL 1578 PALM DESERT, CA 92261 360-3343 )
Name of Applicant (please print) Busine s Address Telephone No.
Darren Wing/John Marcinek
Name of Contractor and JobNForeman Business Address Telephone No.
Contractor's License No.ty Business License No.
Reliance Ins. Co. VZQ88496585
Applicant' nsurance Company Policy Number
FEES: Subdivision Imp vement P mit Class I
Public. improvemen % este dco ructio osts
Private improvements- .1 estimate onstruucc on costs
Minor Improvement Permit —Class I : Se/att shed schedule
Inspection Fee $ 0 PERMIT VALIDATION
Permit Fee 10 PERMIT NO. 1644
Penalty1-5-93
Cash Deposit -Surety Bond DATE.APPROVED
if required EXPIRATION DATE 1-15-93
TOTAL: $V..� 210
Receipt No.
Received by r Date
Recorded by
DATE ISSUED
By
.,_ Administrative Authority
TELEPHONE: (619) 564-2246