2811 (4)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
Subdivision Improvement Permit — Class II I
DATE: September 300 1998 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION PCA West, 'bract 28410 -It Lots 17, 18, 21► 22, 23, 41 5 48.
(Street address or Description of Location)
Rewlss sewer and water lateral*.
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION >s Ca.xx new larara s and
&aai don 0XIstin8 1&terals. $11 ATTACHED CONDITIONS,,
DIMENSION OF INSTALLATION OR REMOVAL
bite px4no. 811 APPROVED PLANS,
SIZE OF EXCAVATION, IF NEEDED
*as PIOUS.
APPROXIMATE TIME WHEN WORK WILL BEGIN xu 19e
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $►���
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
y
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 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.
Signature of Applicant or Agent `"= -
Trans West lousing 7$401 Hwy. 111, La Quint&, EA 92253 (760) 771-3363
Name of Applicant (please print) Business Address Telephone No.
,!ones brothers Construction 85»589 Avsnus U. Coachella, CA (760) 347-2231
Name of Contractor and Job Foreman Business Address Telephone No.
MM !172092 XftW 4153
C
aaorXsnLvi�erauceo. Co. City Busi s�License N, o�
Applicant's Insurance Company t 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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
750
vy�
Receipt No.
Received by Date
Recorded by
OOT p � 1991`
.�/ PERMIT X6MTION
1A ON -11
10/1/98
DATE APPROVED
10%!%913
EXPIRATION DATE
10/1/98
DATE ISSUED
By ...
Administrative Authority
Telephone: (619) 777-7075