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Witliprope"r`'validation '
this form constitutes ani >
a"_ encroachment permit CITY OF LA QUINTA
LAPPLICATION, FOR, PERMIT-
PUBLIC
ERMITPUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
f
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
T = Subdivision Improvement Permit —Class III
Minor Improvement Permit,Class iv—
LOCATION'OFCONSTRUCTION 'Rimo'hn >I-A-Ottih'ra'.!`ritei 27835. Cas1tan Phase 2
(Street address or Description of Location) - F
` i
T� PURPOSE OF'CONSTRUCTION�• '�� a�t�.��' Sketch (attach constructions if a '
R' P. PPropriate)
4�`DESCRIPTION OF'CONSTRUCTION RAA A>"xAyod 'i�na'
' z�•��,
DIMENSION OF,INSTALLATION,OR REMOVAL l^IfAtAll �iy� _,` �py� {` - �y. s -;
L �. r�t'"+5 � *� i }iiiA,e" '1►A#P /1 f'i�tt'�A `i*:1 't �k� , n O�:i�# iPft03pPl ITR 'a ROV
SIZE OF:EXCAVATIONJF-NEEDED = � x►tAtt�t = x ' '
,: • APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME,OF,COMPLETION
ESTIMATED CONSTRUCTION COST,$ `' � �►� L .}i '°`�.
i (Including removal~of all obstruction, materials, and debris, backfilling, com
paction and placing permanent resurfacing and/or replacing improvements)
}In' consideratioon,of the'granting of, this, permit, the applicant liereliV agrees to:
F
'. Indemnify, defend'and.save,the City, its aut%horized a gents,: officers, representatives and employees, harm less .from,an�against any.and all
.� ,. ; �+
penalties, -liabilities or loss resultingtifrom claims or court action_and,arising out of "any accident , lois-or
damage to personsyortpropertyt,.
t h pening or occurring as a proximate result4.of any work' undertaken under the.permit•granted pursuint to`this,application�w, �•'`� L='
Notify theyAdministrative Authority at least °twe`nty-four hours in advanc0f(24) ,the:time when' work will be •started.0 `� .N ;- ' , "tai► . a- f
Comply with,all applicable City Ordinances, the terms and conditions of�the,permit and all applicable rules and regulations of.the'City of t;
La Quinta and to pay for any`additional replacement necessary.as the result of this work
'Signature of App lican{or Agent•
1 ' Box La iatm. '.nn to•g ��
Name of Applicant,(please print) Business Address Telephone,No. ,
:m+e#++r+�+ r t ni�.►z t�rG an ' 2909' giintfot► VA114V Rd. ital1br66k, CAi2s.4476 ',� i
Name of'Contractor and Job Foreman, . S Business Address' Telephone No.
Contractor's License No. City Business License No.
fink►*rA :TwAket a :. 5. 93 RAI
ri
Applicant's Insurance Company's Policy,Number `
" FEES: Subdivision Improvement Permit — Class I I I r� 3` , MAK ' 99 `
Public improvements: 3% of -estimated. construction costs CITY OC' a OUNTA
' •' r't V f LP'1 t+t tV
Private)m'prove'ments:'3%of estimated construction costs
Minor Improvement Permit —Class IV: See attached schedule 1.
a
Inspection" Fee ,< '$�- PERMIT VALIDATION'
Permit Fee Cla'! ' $ ,e
PERMIT NO. ?.729
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:. ' $ 406.
Receipt No.
Received by Date
Recorded by
DATE APPROVED
EXPIRATION DATE ,3/25/99
DATE ISSUED( + } }
,
x Administrative Authority
Telephone: (619) 777-7075
0