2970 (2)Y�
NOTE:
With proper validation
this 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
47t�94
6-1-99
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION IWORSECTI0:3 OF AVE LA FO :DA & CALLE TAMA7.33 A
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION DIG UP CABLE DA2;AGF
DESCRIPTION OF CONSTRUCTION 5' :. 4' PIT III ASPHALT
DIMENSION OF INSTALLATION OR REMOVAL 5' r. 4'
SIZE OF EXCAVATION, IF NEEDED 5' r 4'
APPROXIMATE TIME WHEN WORK WILL BEGIN 6-01-99
APPROXIMATE TIME OF COMPLETION 6-31-99
ESTIMATED CONSTRUCTION COST $ 325.00
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction plans if appropriate)
In consideration of the granting of this permit, the applicant hereby agrees to:
SEE ATTACHED CO,W I T IOr18
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.
i
Signature of Applicant or Agent
H.C.I. FRAIM MILNER 11201 HAIL M ST MIRA LONA, CA (911191 360-7000
Name of Applicant (please print) Business Address Telephone No.
H.C.I / JO23IJEAVER S/A 760-343-3334
Name of Contractor and Job Foreman Business Address Telephone No.
378587
Contractor's License No.
1182
City Business License No.
SELF It1Si XD CERT . ON IFILE
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee 100.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 100.00
Receipt No.
Received by Date
PERMIT VALIDATION
PERMIT NO. 2970
DATE APPROVED 6-01-99
EXPIRATION DATE 7-15-99
DATE I S/SU ECD.
t� �Ad n trative Authority
Recorded by 11 Telephone: (619) 777-7075
City of La Quinta, 78-495 Calle Tam pi o, P. O. Box 1504 La Quinta CA 92253
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