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1903NOTE::.. - With 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 9129/93 Subdivision Improvement Permit — Class II I DATE: Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION YAVBR 1"6"WIDE $4,000 WT ALL ILSE LEGAL Sketch (attach construction plans if appropriate) ROOTS: J3?nMON AT 49 NORTH OUT OF CITY LIMITS DIMENSION OF INSTALLATION OR REMOVAL UATEt 9/29/93 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- 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 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. "„/"//V/Y e9le4a6"e? Signature of Applicant or Agent GPMITB CONSTRUCTION 1'•0, BOX 9011, 'ALM 11188BUt CA 922.35 775-8302 Name of Applicant (please print) Business Address Telephone No. SAMS Name of Contractor and Job Foreman Business Address Telephone No. ON FILE Contractor's License No. City Business License No. ON FILE 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 10.00 Penalty Cash Deposit -Surety Bond if required TOTAL: $ 10.00 Receipt No. Received by Date PERMIT NO. 1903 PERMIT VALIDATION 1903 DATE APPROVED 9/29/93 EXPIRATION DATE 9/29/93 SDATE ISSUED _ 9/299//93 Adminis live Authority Recorded by 11 TELEPHONE: (619) 564-2246 'oN jrguurnNppa,� - •0400 'oN wuroll sm.11148 Alt Wippy =uROy A lulviddy Pa rjrg0WM I R%•.vwv- wyvj $ul 1,4U"Iflddy 'ON "Mil MJwt4uo0 7--- q�r PV r �m>�R1waa to OWIN lIU14 rarrydf'%rolld�y WnWrN ." 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SENDER AT (619) 775-8302.- 6, Palm Springs Branch V.O. Box 9011 Palm Nsed, CA 92ZS-9011 Phone 619/360.4500 FAX 619/3644$70 e . .r� .. s r e . .r� .. s _..4y a�aoee�r Extended Page 2:1 PE1�l�: Su®6tkAIGn Improvement permit Clot$ Ili FubNc imaroverrsentao 3% at'stimetsd construction coots Privet* improvertwIttt 3% of estiftted aonstruct,oft Colt, Mlnoe improvement Permit - Clore IV., $e8 �tteched tChedude ~~�. 1ngpaCt�on Fns � amt Fee e�ity ;"h Oepaoft•Suroty ooh �' requited TOTAU, e 1pt No. P9R__M11'VAt,I0AT10N PERMIT N0, OATS APPROVED EXPIRAT101V ®ATE DATE J$SUE0 By Ad+toINSI slue Authority TBLEPNoNe' 16191664.2246