2656NOTE:
With proper validation
this form constitutes an
encroachment. permit
CITY. OF LA OUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, v
and other like public works improvements in connection with MINOR.IMPROVEMENTS and APPROVED SUBI
ter`. mains
VISIONS
Subdivision Improvement Permit— Class III
DATE: September 29, 1997 ..Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Tract 27899, mouth east corner of Miles Ave. and Adams St.
(Street address or Description of Location)
PU
DESCRIPTION OF CONSTRUCT
Sketch (attach construction plans if appropriate)
SEE ATTACHED CONDITIONS
DIMENSION OF INSTALLATION OR REMOVAL See Flan
SIZE OF EXCAVATION, IF NEEDED See plan
APPROXIMATE T.IME.WHEN WORK WILL BEGIN 9/30/97
APPROXIMATE TIME OF COMPLETION 10/20/97
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.
i ; r Signature ofeApplicant or Agent
Century Crowell 1535 .South "D" St., Suite 200 Shn Bernardino, CA: (909) 381_6007 "�-
Name of Applicant (please print) Business Address Telephone No.
A.A. Austin 387 S.. Arrowhead San Bernardino, CA (909) 884-94.10
Name of Contractor and Job foreman Business Address Telephone No.
13.6867 3422
Contractor's License No. City Business License No.
Commercial Union. FAr.28894
Applicant's Insurance Company Policy Number.
Q
�1V
"'FEES: Subdivision Improvement, Permit — Class I I I .
Public improvements: 3% of estimated construction costs
p Private improvements: 3% of estimated, construction. costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee .. $ 8,471.76
Permit Fee 100.00
Penalty
Cash Deposit -Surety Bond
if required' (as builts) 1,000.00
TOTAL: $ 9,571.76
Receipt No.
Received by Date
Recorded by
SEP
PERMIT VALIDATION
' •
PERMIT NO.' 26.56
DATE APPROVED 9/29/97
EXPIRATION DATE. 9/30/98
DATE.ISSU'fD /9/30/97
By
Administrative Authority
Telephone:.(619) 777-7075