2129With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
L
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
DATE: 4-11-94
LOCATION OF CONSTRUCTION 50th b Park Ave
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 86' beams Hail Route:
North City Limits on Washington
To 50th east to Park Ave
DIMENSION OF INSTALLATION OR REMOVALh14' 10" w legal
L 96' 6'9" rear overhang
SIZE OF EXCAVATION, IF NEEDED Haul Date : 4-12-94
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/o�f the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of t��h�per it and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the rs4ult of this�work.
Minatta Trans.
Name of Applicant (please print)
Si feature of Applicant or
P.O. /24
ox7 Cotati Ca 9A
siness Address
Name of Contractor and Job Foreman Business Address
Contractor's License No.
Applicant's Insurance Company
FEES: Subdivision Improvement 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
Inspection Fee $
10
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10
Receipt No
Received by
Date
800-237-7888
Telephone No.
Telephone No.
City Business License No.
Policy Number
t
e
i
2121,�,v
1 K �
APR 11 1994
PERMIT VALIDATION
PERMIT NO. 2129
DATE APPROVED 4-11-94
EXPIRATION DATE 4-12-94
DATE IS GED 4-11-94
By �
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
0
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