2842' NOTE: ;
.With pro per,validation.. /
this form constitutes an CITY OF LA QUINTA G.
encroachment permit--
APPLICATION FOR PERMIT
PUBLIC WORKS. CONSTRUCTION (ENCROACHMENT)
f OF. T[iB�
For the construction of public or private curbs, .driveways, pavements, sidewalks, parking lots, sewers, water mains
Wand other like public works -improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement' Permit — Class III
DATEa :10%'30%98 = Minor Impr•onment Permit Class IV'
'LOCATION OF CONSTRUCTION Avenidt>! Nuptsitra -and Caa_le 2'aamaxnla.
(Street address or Description of Location)
s PURPOSE OF'CONSTRUCTLON Excavate street to yet to Sketch (attach.construction plans if appropriate)
wit.er. main.
DESCRIPTION OF CONSTRUCTION Revilace 2" mastic
sekii•ce..with coidoer.' SEE .ATTACHED CQN0ITIONS.
D.IMENSION'-OF INSTALLATION OR REMOVAL
-SIZE OF EXCAVATION, -IF NEEDED Apbrou-im te►ly 40 'X 4'"..
APPROXIMATE'T.IME WHEN -WORK WILL BEGIN UnTi o ~
APPROXIMATE.TIME OF COMPLETION Dniklnown.
ESTIMATED CONSTRUCTION COST $ NSA
(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:
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
happening or. occureing *as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrativstarted. e Authority at -least twenty-four (24) hours`.in advance of the time when work will be
Comply with all Tapplicable'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.
JEI�' REY ,7. I111GGAN' Coachella Valley Weitex ��is>rric398-2651
Name. of Applicant (please print) Business Address Telephone'No.
,row coz lids 398-2.651 ex>t.y
Name of Contractor and Job Foreman Business Address Telephone No..
WA N/A
Contractor's License -No. City Business. License No.
N/Ap NSA
Applicant's Insuran ce,Cornpony' 'Policy Number
FEES: Subdivision Improvement Permit — Class
Public improvements: 3% of estimated co nstruction•costs. .
.. Private imp rovements: 3% of estimated construction. costs
Minor Improvement Permit = Class IV: See attached schedule,
•Inspection Fee - $-' PERMIT VALIDATION
Permit Fee " PERMIT NO. 2842
Penalty - 10/29198
Cash Deposit -Surety -Bond DATE APPROVED "
if required "� EXPIRATION DATE 10/29/99
TOTA L: ,' . $ 0
Receipt No.. .
Received by Date
Recorded by
DATE ISSUED 10/29/98
Administrative Authority
Telephone: (619) 777-7075