2785� NOTE:
With 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
l.�
Subdivision Improvement Permit — Class I II
DATE: Sapt. 9, 1998 Minor Improvement Permit .Class IV
LOCATION OF CONSTRUCTION ' Whohinlitton 200' N of Avrouldae Montero,
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Install wire an Sag nft$ Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Expoaa vein and tiaa on
wire.
See attaehad conditione..
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED Varioo
Y
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 8apz' *ju' 199d pAID
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: Jt' OF LA ,`
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. '
k C
Signature'of Applicant, or';Agent
ARB Inc. , 72600 'Vista Chino. Thousaud Pilau � '� " 343-1180
Name of Applicant (please print) Business Address Telephone No.
ansae as above
Name of Contractor and Job Foreman Business Address Telephone No.
14A074 566
Contractor's License No. City Business License No.
St. Paul Fire/Marino KIK08300277
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 $ 0 -
Permit Fee 100.
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
LUU I
Receipt No.
Received by Date
Recorded by
II
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATE
Sept. 80 1998
Sept. 8, 1998
Sept. 8. 1998
DATE ISSUED
By
Administrative Authority
Telephone: (619) 777-7075