2810 (2),, . ti:' �^_ T .. i r, ��'" ;r V -xfw'h _ r>:,�'� •#%�"4•+kr C• :} � ' i � * a l
t - ,�"yi _. „x. � y " ` y '+ •""fr ' } ��''' pit.
------------------------------ -- ---_ _ - fc. 4•t
7, t h '.,:Y•f ,+f. I Ari !7 , * e• 3f ,
! NOTE:
'
'With proper validation
° this form constitutes an CITY OF LA QUINTA w
• encroachment permit v
- - r APPLICATION • FOR `PERMIT . •*+ }� f.83
'' r PUBLIC WORKS CONSTRUCTION, (ENCROACHMENT)
For `the construction of public or private curbs, driveways, pavements, sidewalks, parking lots,lsetvers, watei' mains "tt'
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS . ,
e. Subdivision ImprovementPermit — Class I I I,
DATE: 9/30/98 Minor Improvement Permit Class IV - `
" • LOCATION OF CONSTRUCTION-
F- j
r - (Street address or Description of Locationl - _ s-, - „i •T _ _
21
! Grad or Ma'�onr
PURPOSE OF CONSTRUCTION etch (attach c ction'pI s if ap_pro At tg)
r i
WR 1 1
DESCRIPTION OFCONSTRUCTtON Sracit- — A j�rnk
.6 ,0.00 r yd z 3
t M DIMENSION OF INSTALLATION OR REMOVAL 2 r 5nn T, - F
` L SIZE OF EXCAVATION, IF NEEDED 6 000 Cy r '�r
APPROXIMATE TIME WHEN WORK WILL BEGIN R t nn a"_ to
�T r APPROXIMATE TIME OF COMPLETION 10/14/98 r
.' rf ,• ESTIMATED CONSTRUCTION COST $. 99,000-00
t:. : 2...
i' (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: r.
- - ' I ndemnify;. 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: y
�, - , • happening or occurring as i proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four 124) 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 � '
` t .. - .
• •, y _ - L.e Ouinta and to pay,for any additional replacement necessary as the re It of this work. _ _ . •_ � , -
Sign ure of Applica r Agen
R Ld '760 564-7189`
i= Name of Applicant (please print) , Business Address Telephone No.
�'. A Flores P '0 'Box 1036 LaOuinta` 760/360-0255
z a Name of Contractor and Job Foreman Business Address Telephone No.
61 nn5 t• ;.
Contractor's Lic_enie No:. r City Business License No.
7nri r -h- .Tnguranr•a (~ntn L� GLID683881'504 _
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III °• ' ' t,, r r
' •� est,' 1 gK e - . «')i .• � -
' Public improvements: 3% of estimated construction costs a ' ' ' "
Private improvements: 3% of estimated construction costs • . ti
s 2774=
Minor improvement Permit - Class IV: See attached schedule :+ r
8 J ' Inspection Fee $ PERMIT VALIDATION x ;T
• - r s) -A Permit Fee f �'Sf�•i i V f. Y, ` �;
�. TP PERMIT NO. p s
Penalty ,. r ' �a O r
r •. Cash Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE
.TOTAL: ` $_��—� .r DATE ISSUED �.
Receipt No.
,
.. By
Received by Date ; i, Administrative Authority
" Recorded by 777-7075,"
- Telephone: (619) 777-7075