2406With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
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
Subdivision Improvement Permit - Class III
DATE: 12-12-95 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Rancho La Quinta - Tract 2-^71-2> 3
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Install Storm Drain System Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
Install -,.
rt P �z � o (-P( i9 r t 1+0 PE ,
See attached conditions'
DIMENSION OF INSTALLATION OR REMOVAL
See the approved - fans
.SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 23? CPQ
(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 resultof this w
Signature of cant or Agent G�,i�r '`f4't- rot T `'� "
TD Desert Dev./ Sparks Const. P.O. Box 1716 La Quinta CA•92253 771-194.1
Name of Applicant (please print) Business Address Telephone No.
D.H: Stashi Const. 54-695 Madero La Quinta,'CA 92253 564-6236`
Name of Contractor and Job Foreman Business Address. Telephone No.
" 674651 3020
Contractor's License No. City Business License No.
-Sphere Drake Ins. NAD 859493.
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 $ -" q PERMIT VALIDATION
Permit Fee PERMIT N0. -2406
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
Date
DATE APPROVED 12-12=95
EXPIRATION DATE 2-25-96
DATEI SUE 1 12-95 '
By
Administrative Authority
TELEPHONE: (619) 564-2246
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Ili N i`r COST
I ... SEWER. #27835
642'
8 VCP
25.00
FT
$
_j6j 050.00
25
4" LATERALS
40000
E
10,00000
3
48 "' MANHOLES.
�_—i,800x6
EA
$
5,400.00
4
4 " LATERALS ABANDON
2,000.00
EA
.1 $
8,000.00
4
4" LATERALS INSTALLED
*300.00
EA
$
9,200.00
f
_
CONCRETE ENCASEMENT
1,.000.1?
EA
$
1,000.00
AXTEST
1,000.00$
1,000.00
JET &IDIO
.V
2, 000.00
$
2,000.00
MOVE IN EQUIPMENT
1,500.00
$
1,500.00
$
54,150.00
STORM DRAIN # 27835
60'
18" HDPE
Is.
11,000.00
1
18" X 18" TEE
$
1,200.00
1
18" 22 112 DEG BEAD
$
1,500.00
3
18" COUPLINGS
300.00
EA
$
900.00
4
18" REPAIR COUPLINGS
300.00
EA
$
1,200.00
2
24" X 24" CATCH BASIN
1,500.00
EA
$
3,000.00
2
36" X 36" CONCRETE COLLARS
750-00
EA
$
1,500.00
2
LOCAL DEPRESSION
1,500.00
*EA*
$
3,000.00
$
23,300.00
2
D.H. STASHI, INC.