2840 (2)With proper validation
this form constitutes'an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR -PER IT
k 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 provements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
l
DATE: • 10
LOCATION OF CONSTRUCTION
I
.(Street address or Description of'Location)
.PURPOSE OF CONSTRUCTION F
DESCRIPTION OF -CONSTRUCTION
eervices, betkfill
Subdivision Improvement Permit — Class II
Minor Improvement Permit Class IV
West— Tract .28522
$eryi"Sketch (attach construction plans if appropriate)
street, install
DIMENSION OF INSTALLATION OR REMOVAL See gppitoy'e& plans.
SIZE OF EXCAVATION, IF NEEDED See
APPROXIMATE TIME WHEN WORK WILL BEGIN 10/26/98
i r
SEE ATTACHED CONDITIONS.
SEE APPROVED PLANS... ,
APPROXIMATE TIME OF COMPLETION 11/Q8
ESTIMATED CONSTRUCTION COST $ 20,000.00
(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 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
Bristol Construction lNe., 73-929 Larrea Palm Desert, CA
Name of Applicant (please print) Business Address Telephone No.
.Tones Brothers` Cc5nstruction P.O. Box 905, Coachella, CA
Name of Contractor and Job Foreman Business Address Telephone No.
XXXMM 172092 153
Contractor's License No. City Business, License No.
SAFECO GLAA130898
Applicant's Insurance Company Policy Number
FARFEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs OCT 2 19gw,
Private improvements: 3% of estimated construction. costs Minor Improvement Permit - Class IV: See attached•schedule UINTA
r F LA 0
Inspection Fee - $ 600.00 PERMIT VALIDATION
Permit Fee 100..00 ti 2i340
PERMIT NO
Penalty
Cash Deposit -Surety Bond
if.required
TOTAL: $ 700.00
Receipt No.
Received by
Date
✓DATE APPROVED 10/26/98
'EXPIRATION DATE 10/26/99
DATE ISSUED ,10t26/98
By
Administrative Authority
Recorded by •,
Telephone: (619) 777-7075