1658FNOTE: .-�....... ,
With -pr
.pper validation
this form'constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)-
'For
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
r
1/27/93 Subdivision Improvement Permit— Class I I I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION `
(Street addressor Description of Location) ~
I; "$ BQUIPMM
PURPOSE OF CONSTRUCTION: Sketch (attach construction plans if appropriate)
t $AUL ROUTB
DESCRIPTION OF CONSTRUCTION 966 LOADER 10'W -15-6"H JFPERSOII @ FM WARING
100.000 WRIGHT SODTH _.0N JEBFERSON TO HWY 111
@ WASHINGTON
DIMENSION OF INSTALLATION OR REMOVAL
HADL DATE: 1/27/93
+ SIZE OF°EXCAVATION, IF NEEDED
APPROXIMATE.TIME WHEN WORK WILL BEGIN
s.
APPROXIMATE TIME.OF COMPLETION
ESTIMATED CONSTRUCTION..COST $ _
(Including' removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permaneiit resurfacing and/or replacing improvements) A r,4'0'1 < A ArUA Q4—')A 07 14
.
-10'-. CASHT UTAL IavtwQ
In consideration of, the granting of this permit,' the applicant hereby agrees to:
r 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 t, 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 thetity of
'La Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent • ,'
_atmR-CONST PO 801`9011 PMX DESERT *2235-9011 (619) 775-8302-
Name
75-8302Name of Applicant (please print) Business Address Telephone No. i,
Name of Contractor and Job, Foreman Business Address / Telephone No.
011• FILA=F 01i FILE
Contractor's License No. City. Business License No.
ON Fm ON' FM
j. Applicant's Insurance Company , 4. • , Policy Number 1 �"
FEES: !Subdivision Lmprovement Permit — Class 1.11
Public improvements: 3/of
estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit - Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
150.00
$ 150.00
Date
PERMIT VALIDATION
1658
PERMIT NO.
DATE APPROVED
1/26/93
EXPIRATION DATE 1/27/9
DATE ISSUED
.. Y
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246