1734NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA ? .
encroachment permit ,
' APPLICATION FOR PERMIT - $
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) tiS
,. �IOF IHB9
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 APPROVEDSUBDIVISIONS
Subdivision Improvement Permit — Class II I
DATE: 5/1/03;Minor Improvement PermitClass IV .
'fy LOCATION OF CONSTRUCTION 53-975 Ave Cortez La Quinta r
(Street addressor Description of Location)
4 PURPOSE.OF CONSTRUCTION Driveways Approach Sketch (attach construction'pla'n+s if:appropriate).
DESCRIPTION OF CONSTRUCTION
PER, RIVERSIDE COUNTY STD 4# 207
(ATTACHED)
DIMENSION OF INSTALLATION OR REMOVAL
t.
r
,SIZE OF EXCAVATION, IF NEEDED.
SIC,.
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/11/93
APPROXIMATE TIME OF COMPLETION r
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: ({sj
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 alliapplicable City Ordinances, the terms and conditions of -the permit and all applicable rules and.regulations of the City of
La_ Quint and to' pay for any additional• replacement necessary as the. result oU this ork. +
` l
Signature of App 'cant or Agent'
Majestic Homes:North PO Box 76 La Quinta'
Name of Applicant (please print) Business Address Telephone No.. '
JMK Development 11684 Ventura Blvd.. Studio.City 91604. {213) 656-3153
fi,, y
Name of Contractor and Job Foreman Business Address ?: Telephone No.
B590684 2537
Contractor's'License No. City Business License No:. `
Soottsdale 92/GLS384718
Applicant's'Insurance Company Policy Number .' •'•
FEES: Subdivision Improvement Permit = Class,.lI l
Public improvements: 3% of estimated'construction costs
Private improvements: 30/q of estimated construction costs
Minor Improvement Permit .- Class IV: See attached schedule
Inspection Fee $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond,
if required
`. TOTAL: „ $ 30.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION:
PERMIT -NO. 1734 '~
DATE APPROVED :• 5/11/93 .'
EXPIRATION DATE
DATE.ISS.UED 5/Ll/93
r Administrative Authority!
`TELEPHONE: (619) 564-2246 '
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