2787NOTE:
`With -proper validation
this form constitutes an CITY OF LA QUINTA
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
Subdivision Improvement Permit -, Class III
•'DATE: September.9, *1998 .> 'Minor Improvement Permit'Class IV '
'LOCATION OF CONSTRUCTION Washiaaton between 42nd and Him. 111.
lStreet.address or Description of Location)
Cid. C.P. wires
PURPOSE OF CONSTRUCTION Sketch (attach construction plans.i-f appropriate)
DESCRIPTION OF CONSTRUCTION Remove valve. stands,
check CiP. . may inatail nem wises., SEE ATTACHED C014DiT1014S.:
'DIMENSION OF INSTALLATION OR REMOVALvaries
SIZE OF EXCAVATION, IF NEEDED varies
APPROXIMATE TIME WHEN WORK WILL BEGIN 9/10/9
APPROXIMATE TIME OF COMPLETION µ9/30/98
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 Len work will be started`
Comply with all applicable City Ordinances, the terms and conditions of the permit a#a/ll.l/applicable rules a6 regulations of the `City of
La Quinta and to pay. for any additional replacement necessary as the result ofthis worK.
Signature of /Applicant or Agent
ARB INS'. 72400 Viata�aChino, Thousa d P�dlta9 (760) 343;] I80
Name of Applicant (please print) Business ' ddss Telephone No.
lama as above
Name of Contractor and Job Foreman Business Address Telephone No.
194079 5.66
Contractor's License No. City Business License No.
St. 'P4 ul Fire/Marine KK08300277
Applicant's Insurance Company Policy Number
.,:FEES: 'Subdivision Improvement Permit — Class II I
Public improvements: 3% of estimated construction. costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV.: See attached schedule
Inspection Fee $
Permit Fee 100.
�p' r
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ loc.
Receipt No.
Received by Date
Recorded by
SAI -
SEP17 i999
OF LA, .k.; �
PERMIT VALI A 1ON
PERMIT NO. � � '
DATE.APPROVED 9-9-9$
T
EXPIRATION DATE 12-31-98'..'
DATE ISS. ED' ABy- AA
Administrative, Authority
Telephone: (619) 777.-7075