2848NOTE:.; With proper,validation. •
this form constitutes an "
encroach ment.perm it-
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 I II
DATE 1TT3 9$r 4 Minor, Improvement Permit Class IV- `
LOCATION OF CONSTRUCTION Lot 17. Tract 21643. PGA'West HOA-Maintenance Facility, SDY 97-615
(Street address or Description of Location)
PU_ RPOSE OF'CONSTRUCTION 'Construct eutty drivetvaY Sketch (attach construction plans if appropriate)
dad sAW Street.
DESCRIPTION OF CONSTRUCTION .RamovA and renlAcs
ds nndrA 'erngl Rutt-eril And ccxrb Rrtd nut4�±r,
- _ SEE ATTACHED CONDITIONS..
r DIMENSION.OF INSTALLATION. OR REMOVALRea,telatn,%'
"SEE, APPROVED: PLANS
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE -TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTPMATED CONSTRUCTION COST $ XIM $5..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 tbe.)City of
La.Quinta and to,pay.for any additional replacement necessary as the result ofitis work. ✓
Signature ;Applicantorf Agent
Ir
PGA Weet '.Re6idential' A..sgec. , Inc. F:0. Bow 10 , 'La. Quinia. CA 99253 760/771-1234
Name of Applicant (please print) Business Address . Telephone No.
URR Builders 77-370 Springfield Lane,, Suite D, Palm Aeser.t., .CA-_
Name of Contractor and Job Foreman, Business Address Telephone No.
Contractor's License No. City Business License.No. F
'Yarmers Insurance Group 6.0062 27 7
Applica'nt's Insurance Company: " Policy Number
FEES.•'. Subdivision Improvement Permit Class III ;
Public Improvements:.3%.of estimated construction costs
Private improvements:, 3% of estimated construction costs .
:Minor Improvement Permit— Class IV.: See attached schedule 48
;
Inspection Fee $ PERMIT VALIDATION
Permit Fee .
�100. 2848'
PERMIT NO.
Penalty r (100) *Cr6dit''Due
Cash Deposit Surety Bond DATE APPROVED 11-3-9$
if required, - EXPIRATION DATE 11-3-99
TOTAL $
DATE ISSUED
Receipt'No.
By —
Received by Date v Administrative Authority
Recorded by 11 -. -,Telephone: (619) 777-7075.