2288NOTE:
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
DATE: 1-11-95
LOCATION OF CONSTRUCTION 54-225 Alvarado
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Construct 61 sidewalk
DESCRIPTION OF CONSTRUCTION Construct 6' concrete
sidewalk from curb to property line
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1-12-95
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
APPROXIMATE TIME'OF COMPLETION 1-15-95
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:
Sketch (attach construction plans if appropriate)
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.
Signa ure of Applicant or' gent
Donald Peterson 54-225 Alvarado La Quinta, CA 92253 564-5631
Name of Applicant (please print) Business Address Telephone No.
Owner/ Builder
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company Policy Number
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 $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
20
10
$ 30
2288
PERMIT VALIDATION
PERMIT NO. 2288
DATE APPROVED 1-11-95
EXPIRATION DATE
DATE ISSUE
By
1-20-95
1-11-95
Received by Date 9
i
Recorded by TELEPHONE: (619) 564-2246 '