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2844
- -f proper validation is 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: 9/29/98 Minor Improvement Permit Class IV LOCATION°OF CONSTRUCTION La Quinta Chamber 10k race route, Ave. 52 from Washington St. to east of Madison Street, see traffic control drawings. (Street address ortiDescription of Location) PURPOSE OF CONSTRUCTION Annual 1OK/5K Run _Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Traffic control for roast clonuresl. DIMENSION OF INSTALLATION OR REMOVAL See traffic nnntrol, nl.nns. SIZE OF EXCAVATION, IF NEEDED None• y APPROXIMATE TIME WHEN WORK WILL BEGIN 11/15/98 APPROXIMATE TIME OF COMPLETION 1/3 S/98 ESTIMATED CONSTRUCTION COST $ A (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 ATTACHED TRAFFIC C014TROL PLANS. 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 propee rty 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 /t�his� work. • Tt.��V'�at/Y��t/ t I��J�"� �J ram. Signature of Applicant or Agent LA Ouinta Chamber of Commtrce XNS 78-371 Hwy. 111, La Quinta, CA 92253 760/564-3199 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. ..., 2612 Contractor's License No. City Business License No. « Gulf Tnnn"an.ca Cn. r_ /n Ch Ari rir Al A70 I1 Applicant's Insurance Company -Policy Number 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 $ 0 1 Permit Fee 100 Traffic eontrol 1Peral"ty Equip. Cash�Depost-Slarety Bond ('j Rtrequ,red Rental Fee �© TOTAL: $�+ (f 0 Receipt No. Received by Date PERMIT NO NOV. 13 1998 284 t I,- PERMIT %A IDA�ION � � 2844 DATE APPROVED 11/3/98 EXPIRATION DATE 11/16/98 DATE ISSUED 11/9/98 t Administrative Authority Recorded by Telephone: (619) 777-7075