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2726NOTE: �'• " 'I 6 r, With, proper ;validation this form, constitutes an CITY OF LA OUINTA 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 - Subdi'vision, Improvement Permit — Class l II k, DATE: Minor Improvement Permit'Class IV -`-LOCATION OF CONSTRUCTION .Rancho La Quintd,, Tr#ct 27$33 (Street address or Description of Location) PURPOSE OF CONSTRUCTION Tiint>:al-t storm drain ime rove- Sketch (attach construction plans if appropriate) 'DESCRIPTION.OF CONSTRUCTION See pl:ahs See attached cottditiona.. See approved plana by Watacia b Christian-- ' DIMENSION OF INSTALLATION OR REMOVAL., See gland. sin. SIZE OF EXCAVATION, IF NEEDED Sr��1aue• APPROXIMATE TIME -WHEN WORK WILL BEGIN 3/19/9$ ; APPROXIMATE TIME OF COMPLETION 4/15/98 ESTIMATED CONSTRUCTION COST $ 23.E©0 (Including removal of•all obstruction, materials, and debris, backfilling, coni paction. and placing' per resurfacing and/or replacing improvements) 3 " 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�resu t of this work. : Signature of Applicant or Agent T -.:I)-• t)i:R rr � _VAJODiAenr. P.A. Box 1716, La Ouitna, CA' 92253 (7'60) 771-1941 Name of..Applicant.(please print) Busines''s Address: Telephone No. D.H..Stashi; Iiic., 64695 Ave. Madero,: 1.a Quintal .CA:92253 (760) 5644236 Name of Contractor and Job "Foreman Business Address Telephone No. 701414ct contractor's License No. City Business License No. St. .Paul Faire. k Karina C'K0842396'.• Applicant's Insurance Company Policy Nurhber- FEES: Subdivision 1diprovement Permit — Class III Public improvements: 3% of estimated construction costs" 'Cf 1 YOFALA OWNTA Private improvements: 3% of estimated • construction'costs Minor Improvement Permit'— Class IV: See attached schedule • 699 ,. .. � Inspection Fee $ PERMIT !VALIDATION Permit Fee 100. 2726 PERMIT ,N0. •Penalty3/ 19/9$ Cash'Deposit-Surety Bond DATE APPROVED if required EXPIRATION "DATE 3/I9/99 TOTAL: $79919/98 ISSUED 3/19/93 Receipt No. By. Received by Date r v Administrative Authority Recorded by Telephone: (619) 777-7075 e 1_