1663NOTE:
With.,proper.val idation
this form constitutes an CITY OF LA QUINTA
encroachment permit
► APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
r
7
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
LOJ_1111to
1/29/93
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
LOCATION OF.CONSTRUCTION 51-975 and 51-955 AWR AFEWMA-
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION A�
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETIONPOP) g00
ESTIMATED CONSTRUCTION COST $
(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:
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 conditioasture
nd all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as tork.
icant or Agent
85 ;f.QNT-EZMjA 66. QUINT+.
Name of Applicant(please print) Business A dress154
Telephone No.
FRED STURNER
Name of Contractor and Job Foreman Business Address Telephone No.
642348 2534
Contractor's License No. City Business License No.
SCOTTSDALE INS CO GIS496817
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
•'�. Public improvements: 3% of estimated construction costs 005.8 'AIR
Private improvements: 3% of estimated construction costs r
Minor Improvement Permit — Class IV: See attached schedule 1662
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No
Received by
10.00
Date
PERMIT VALIDATION
PERMIT NO. 1663
DATE APPROVED 1/29/93
EXPIRATION DATE 2/5/93
DATE ISSUED " ' 1/29/93
By
Recorded by 11 TELEPHONE: (619) 564-2246
Administrative Authority