27974
:_4
w s
NOTE:..,
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 I I I
DATE: Seotetaber 16.. 1998 Minor Improvement Permit Class IV
LOCATION 0'F CONSTRUCTION -Hr". 111 at D'Ana .Palms Idd.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Mobil Gas Station Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Clear' and grub site.,
Rrade-building pad. SEE ATTACHED CONDITIORS.
DIMENSION.OF• INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN Se0tember 21, 199$
APPROXIMATE TIME OF COMPLETION ~
ESTIMATED CONSTRUCTION COST $9,325.00
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent. resurfacing and/o% 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 ferms 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 thin work% -
Signature of Applicant or Agent
Name of Applicant (please print) Business Address Telephone No.
ONTI Coaasti;ruetion Co,, Iuc. 31831 Camino. Capistrano, ,#150 San -J a i CA
Name of Contractor and Job Foreman. Business Address Telephone.No.
UXK 716396.E 5221
Contractor's License No. City Business License No.
Berv.Merritt PL 119975•
Applicant's Insurance'Company Policy:Number'
FEES: Subdivision Improvement Permit -Class III
Public improvements: 3% of estimated construction costs _SEP 1 8 1998
Private improvements: 3% of estimated construction -costs
Minor Improvement Permit Class IV: See attached schedule LA.�'tt IN`T ,
Inspection Fee $ 279.75 PERMIT VALIDATION 4a(lJ Illy
Permit#Fee 140•00 PERMIT NO. ' 2797
Penalty 9/1?/9E
Cash Deposit-Surety'Bond t ;;�� .�� t DATE APPROVED 98 %�'
if required tr� t�t/I°a�/'�1�1i/�1�. $`NC T EXPIRATION DATE 9%17/x"' r cy
TOTAL: $ ) 9! 9 .-715
DATE ISSUED
Receipt No.
gy ld/tw�it✓�-.
Received by Date '- Administrative Authority
" Recorded by Telephone: (619) 777-7075
N