2847NOTE -:
J
With -proper validation,,
thus form constitutes an .
' . encroachment permit 'CITY .'OF,'ILA 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 III
'DATE: 10��O198 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Madison Street, south of Airport; Blvd. •..
.(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Provide temporary Dower, ' Sketch (attach construction plans if appropriate)
to�.Traci 28444.
DESCRIPTION OFrCONSTRUCTIONInstall overhead
'electricol.,lines a�. ros�aa Madiaoa Street,
.•: I _ SEA ATTACHED CONDITIONS.
DIMENSION OF,INSTALLATION OR REMOVAL 1= • 110 .€t;.
SIZE OF EXCAVATION', IF NEEDED tt/a
APPROXIMATE TIME`WHEN WORK WILL BEGIN Nov. 4. 19913
APPROXIMATE TIME OF COMPLETION Nov. 4.1998
`ESTIMATED CONSTRUCTION COST $1000.00
(Including removal of all obstruction, materials, and debris, backfilling, com
paction and' placing permanent "resurfacing 'and/or replacing improvements)
In consideration of '.the granting -of this permit, the applicant.hereby agrees to:
Indemnify, defend, and 'save the City,'its.authorized agents, officers, representatives and employees; harmless from and against any and all
penalties, liabilities.or loss resulting from claims or court action and arising out of any accident, loss or•damage•io persons -or property
.'happening or occurring as a proximate result of any work undertaken under the permit granted I pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will•be started.
Comply with all .applicable City Ordinances, the terms and conditions of the permit and all applicable•rules and regulations of the City of
i La Quinta and to pay. for any.additiorial replacement' necessary as the result of. this work.
r" Signature of Applicant or Agent.
Cavntones. G,61d :West' LLC 200 M. Wasi inlaton Ave. -. Escondido'. CA ' 92025 '760839-8238
Name of. Applicant (please print) Business Address Telephone -No.,. -
Ave.. Escondido,°CA 92025
Shaand.n Gommu'nitits of Callforida 200 E. Washington I&^,�02�,-�a0
Name of.Contractor and Job Foreman. Business Address Telephone•No.
6$b690 �, 54,13
Contractor's License No: City Bu' sineshicense No.
United.. , it lts a ura ace Company G•LA 1.252.307
Applicant's Insurance Company Policy Number ..
FEES: Subdivision Im'proyement.Permit — Class III NOV" U 4 1998
Public improvements: 3% of estimated construction costs
Private. improvements: 3% of estimated. construction "'costs CITYF LA QUiN�'�
Minor Improvement Permit — Class IV: See attached schedule � 4
Inspection Fee_ $ PE MIT VALIDATION
Permit Fee y 100.00" 2847
PERMIT NO.
Penalty
Cash Deposit Surety Bond, DATE APPROVED 10/30/98
if required EXPIRATION DATE 10110/99
TOTAL:
a 100.00 10/30/98
$ DATE ISSUED
Receipt No.
Received by Date �A Administrative Authority
Recorded by ' !� Telephone: (619) 777-7075