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1687AtJOTE: �V�tlith 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 DATE: March 9, 1993 LOCATION OF CONSTRUCTION 54-625 Avenida Barmndatg Subdivision Improvement Permit — Class I I I Minor Improvement Permit Class IV (Street address or Description of Location) PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Per Riverside County Std. x`207 (Attached) DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 3111/93 APPROXIMATE TIME OF COMPLETION 3/19/93 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 i 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. E Comply with%ll 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 Delia Construction Co. 1025 Harding, Awmue, Suits 203 Venice, CA 310-305-1248 Name of Applicant (please print) Business Address Telephone No. Mr. Joe Delia Mr. Tom Finers Same as above Name of Contractor and Job Foreman Business Address Telephone No. 493782 Contractor's License No. \ Tranacontinental Ins, Co. 2838 City Business License No. C01 12953574 Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit —Class III 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 Recorded by $ 20.00 10.00 $ 30.00 Date lio5i6IFASN ibTOT219-93 30.00 i0 16$7 PERMIT VALIDATION PERMIT NO. 1687 DATE APPROVED EXPIRATION DATE 3/9/93 3/19/93 DATE ISSUED 3/9/93 By Administrative Authority TELEPHONE: (619) 564-2246 20.00 2VA03 a�ra�a2 i'0�0v reel ' �IL.� �I .i�Tullau 41.1.,./161 Ir LOX UTAOLOT90 CofMCX W." 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