1731NOTE;l .
With proper validation
this form constitutes an
encroachment permit
CITY. OF LA QUINTA .
'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
Subdivision. Improvement Permit — Class III
DATE: 5/6/93 Minor Improvement Permit Class IV
LOCATION -OF CONSTRUCTION Ave 58
(Street address or Description of Location)
Move E ui meat ,
••• PURPOSE OF CONSTRUCTION Q p Sketch (attach construction plans if appropriate)
w DESCRIPTION OF'CONSTRUCTION
Quarry! oGr°�li"$b 9 0 <Q(?i4
jed
DIMENSION OF INSTALLATION OR REMOVAL 13'6" High 145..
Wide, 95,000#
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 �j� �� ��J�U'C7r^�
paction and placing permanent resurfacing and/or replacing improvements) _� 1. � („i �"''�' t•9/
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. pursuaq.'; o this application.•
• Notify the .Administrative "Authority at least twenty-four (24) hours in advance of, the time when work..will be started.
Comply .
p y .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.
-igvlv.o Ag licant or Agent
James,E Simon Co PO Box 10990 Indio 92200 347-5399.
-Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
521795 1217
Contractor's License No. City Business License No.
: St Paul Fire,& Marine 198120
Applicant's Insurance Company Policy Number
FEES: . Subdivision.Imp'rovemenf.Permit.=Class 111
Public improvements: 3% of -estimated construction costs
Private improvements:.3% of estimated construction costs
Minor Improvement Permit =Class IV: See attached schedule'..
• x`
Inspection Fee $ PERMIT VALIDATION'
10.00 1731"
Permit Fee PERMIT NO. ^
Penalty DATE APPROVED 5/6/93 _
Cash Deposit -Surety Bond
if'required EXPIRATION DATE '5/6/93
s , TOTAL.:10.00 5/6/, / / ,/
$ DATE ISSUE , 93
Receipt No.
By:
Received by Date i fitlministrative Authority
Recorded. by TELEPHONE: (619) 564-2246 .
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