2840NOTE: �• i
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
DATE: 10/26/98
LOCATION OF CONSTRUCTION PGA West " Tract 23522
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Provide sower and water 2""'"Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION fteayats its street, Install
services. backtiii iiid repave.
DIMENSION OF INSTALLATION OR REMOVAL bee approved plAns.
SIZE OF EXCAVATION, IF NEEDED 5" approved puns.
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 0,005.0
(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:
SEE ATTACHED CONDITIONS,
SEE APPROVED PLANS.
f
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
Iristol: Constructiou Iles. 73-929 Larr'" Palm Desert, CA
Name of Applicant (please print) Business Address Telephone No.
Jones Brothers Construction P.O. Box 905, Coachella, CA
Name of Contractor and Job Foreman Business Address Telephone No.
172092 153 �
Contractor's License No. City Business License No.
SAnC0 GLAA130898
MA IM
Applicant's Insurance Company Policy Number
r! .
FEES: Subdivision Improvement Permit — Class I I 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 $ 600.00
100000
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 700.00
Receipt No.
Received by Date
Recorded by
31TY OF LA 0UIN-friA
PERMIT VALIDATION
PERMIT NO:
DATE APPROVED
EXPIRATION DATE
2840-
10/26/98
10/26/99
DATE ISSUED 101-26/98
s
By,',: :.
Administrative Authority
Telephone: (619) 777-7075