1745NOPE .
With proper validation
this form constitutes an ITY OF LA QUINTA
encroachment permit C
APPLICATION FOR PERMIT -
'
r PUBLIC WORKS. CONSTRUCTION (ENCROACHMENT). ��• gw
s' For the construction of public or private curbs, driveways, pavements, sidewalks, parking- lots, sewers, water mains
P and other Like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS,
G
Subdivision Improvement Permit — Class III
DATE: .-..5-21=93 Minor Improvement Permit Class.IV
LOCAT10N•OF CONSTRUCTION '
(Street address or Description of Location) `
PURPOSE OF CONSTRUCTION move equipment Sketch (attach coristructiomplans if appropriate)
•DESCRIPTIO,N.OF CONSTRUCTION D-9 dozer. a 1�;� <pq_-)i.- 3' 13
east 'endo $SS51$t wit u�� o ec>� Q Oa
y.
DIMENSION OF INSTALLATION OR REMOVALwt 103,000•
all else legal
SIZE OF.EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 5'21"93
APPROXIMATE,, TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including" removaGof all obstruction, materials, and debris, backfilling, com
li ,
• p'actio' and_•placing permanent resurfacing and/or replacing improvements):
In consideration of...the granting of. -this permit, the applicant hereby agrees to: �. t
Indemnify,.:deferid and save the City, its authorized agents, officers, representatives and employees, harmless fromand,again'st 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 thi ork.
w Signature o Applicant or Agent
James Simontoe P.O. Box 10990Indio 'CA 92201 347-5399
Name ofA'p,plicant• (please. print) Business Address* :� . I Telephone No. .
Name of Contractor and Job ForemanBusiness Address ; Telephone No:
5217.9.5 12.17 ;
Contractor's License No. City Busiriess.'License No.
Applicant's Insurance Company Policy Number
FEES: .:Subdivision Improvement Perrriit `-Class I I I
t'Public,improvements:3%of,estimated construct ion, costs
'r, t Private improvements: 3% of estimated construction costs
.Minor Improvemenf.Permit — Class IV See attached schedule
Inspection Fee $
Permit Fee.'
Ac •
Penalty
Cash Deposit -Surety Bond
if required
,"TOTAL: $ 10
4
Receipt,No
• Received- by. Date
I Recorded by
4t I
1145
PERMIT VALIDATION
PERMIT NO. ' 1745 !'
DATE APPROVED 5-21-93'.
EXPIRATION DATE 521-93_
5-21-9
DATE ISSU D
By
' Administrative Authority
TELEPHONE-. (619) 564-2246
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