1889NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
f % APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
t .
For, the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
brand other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE
9-22-93
LOCATION OF CONSTRUCTION Ave 52 & Bermudas
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION ove Equipment
DESCRIPTION OF CONSTRUCTION WA 430
DIMENSION OF INSTALLATION OR REMOVAL 1114"wide
111,000 lbs all else legal
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 9-23-93
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Haul Routes
Washington to 52 west to Bermudas
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
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 perrSii?and all applicable rulesand regulations of the City of
La Quinta and to pay for any additional replacement necessary as the resu�f tlyis work. _
�Sig� ure of Applicant or Ag ,Ftt'-
Kenko Const. 1694 91st. Blaine 55449 1800-344-1912
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
y
Contractor's License No. _ City Business License No.
on file on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class II I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 10
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10
Receipt No.
Received by Date
Recorded by \
MIN
PERMIT VALIDATION
PERMIT NO. 1889
DATE APPROVED 9-22-93
EXPIRATION DATE 9-23-93
DATE ISSPI ED 9-22-93
By
Administrative Authority
TELEPHONE: (619) 564-2246 4
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CITY OF fiLl���'-'----------
OEtARTMEN/T OF PUBLIC WORKS
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