16714� NOTE:
With.proper validation
this;form___constitutesan "` — ._ CITY OF LA QUINTA
encroachment permit'= Z „ __
APPLICATION -FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
f 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
Subdivision Improvement Permit - Class I I I
DATE: 2-12-93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION '32030 Vi11A `
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Per Riverside. County Std. No. 207
(attached)
DIMENSION OF INSTALLATION OR REMOVAL'
SIZE OF EXCAVATION, IF'NEEDED
.APPROXIMATE TIME WHEN WORK WILL -BEGIN
APPROXIMATE TIME OF COMPLETION ='
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:
IndemAify, 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
General Contract Mgmt , F.O. Box S9 La Quintet 564-1486
Name of Applicant (please -print), 1, Business Address Telephone No.
r
Name of Contractor and Job Foreman Business Address Telephone No.
524325
Contractor's License No { City Business License No.
Crusader ag1020488
Applicant's Insurance Company Policy Number
FEES: Subdivision, lmprovement Permit — Class III 185"1)AIR NNE --1.2—q3 30 0010
Public improvements: 3% of estimated construction costs Sr! i H
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule'
Inspection Fee $ 20
Permit Fee 10 '
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No
30
Received by v Date
A
t671
1
PERMIT VALIDATION
PERMIT NO. 1671
DATE APPROVED 2-12-93
EXPIRATION DATE 2-28-93
-12-93
DATE ISS ED
By D
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246