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2380I OTE: rrtr, proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT 41 PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) I 1 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: 9-21-95 LOCATION OF CONSTRUCTION Subdivision Improvement Permit —Class II I Minor Improvement Permit Class IV Acacia Homes Tract 23268 Lots 170 & 185 thru 199 (Street address or Description of Location) PURPOSE OF CONSTRUCTION Construct Driveway approaches DESCRIPTION OF CONSTRUCTION Driveway approaches DIMENSION OF INSTALLATION OR REMOVAL 16 approaches SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 9-27-95 Sketch (attach construction plans if appropriate) Per Riverside County Std 207 O Q is Fp 0 ,99 APPROXIMATE TIME OF COMPLETION 10-15-95 J^ I, 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 re o t 's ,i Signature of Applica Ur Agent Acacia Const. 8141 E. Kaiser Blvd Anaheim Ca (714) 282-5800 Name of Applicant (please print) Business Address Telephone No. Rick Shay Name of Contractor and Job Foreman Business Address Telephone No. B-293954 1612 Contractor's License No. City Business License No. Certificate on file Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class 111 r Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ 320 11 Permit Fee 10 Penalty Cash Deposit -Surety Bond if required TOTAL: $ 330 Receipt No. Received by Date Recorded by 2380 PERMIT VALIDATION PERMIT NO. 2380 DATE APPROVED EXPIRATION DATE 9-21-95 10-31-95 DATE ISSUtD ,21-95 By- 2&i6fte:�= Administrative Authority TELEPHONE: (619) 564-2246 M NOTE: With proper validation this; form connlnras an encroaChrnent osrmrt CITY OF LA QUINTA APPLICATION FOR PERMIT -PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For the aonstiuction of public or private curt%, driwwaw; pavements, sidewalks. parking lots. sewers, water main$ and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement Permit — Clan III Minor Iltmovemem Permit Gan IV (Suave amreu at Oeampuon of Looeofto PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST S (Including remove' of all obstruction, materials, and debris, backfilli% tom. Faction and Placing permanent resurfacing and/or replacing improvemenesl In consideration of the granting of this permit, UN applicant hereby agras to: 1 construction plans if approprianl Indrnnrh, defend are law ao GN. its sutnorized operas. ofr=n, nprt ant tivee ane empbvew harftm tram Wd.apainat any and as penrtiea. 14witiel or Ion %"Wong from claims or court anon aro wiaiq out of wrty accidenl. los or denies, to owaim or Oraaany aaPPenuy or owu nap s a pratimeo raw" of amp wort undrtattan under me ow"w pentad oWfyMl to this atetlstian. Notih Ina Admrndtrstna Audgritp at leas tlrarnv-four 124) hoes M aWrna of Ilia Gtr wean wort will be atarta a Comav vera au SOViCubta Gtp Ordinar uta tarn" ane oofttidr0 of dta Penna and au aoploble rules "raplrlatrorla df the Guy of V 0ul1110 and to Pay far'any additkw l ndraoarrlmt nevmry as Via raaWt of Ale wwai. / r Name f Applicant (please 5I�rla a of A�;� t or Busiren Address Talsnke C�i4iZgz 58� Business Address Telephone No. Y a GPLBusrness LiCenp No. /re .;.r APPllcant t insurance Company OICU. TY Policy Number FEES: Subdivision Improvement Permit —Clan III Public improvements: 3% of estimated construction dose Private improvements: 3% of estimated Construction eosbl 130 2 6 Minor Improvement Permit — Clap IV: See studied sdsedult . Inspection Fee S �Zft% PERMIT VALIDATION Permit Fee 1 D Penalty PERMIT NO. Cash Oeposlt•Sursty Bond DATE APPROVED if reouired TOTAL: i 33E� Receipt No. Received by Date Recorded by EXPIRATION DATE DATE ISSUED By � Administrative AuMwity 777-7075- '1ELEPHONE: f619156*Q1m J S , . ,} � f a (� ,' . � � � r � f � i J 1 ' � J S , . ,} � f a (� ,' .