3099NOTE:
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
Subdivision Improvement Permit — Class III
DATE: 12/9/99 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION FRED WARING @ E SIDE WASHINGTON ST.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION TNRTAT.T, F.T,FCTRTCAT, CONUT1TT Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION ( ITT RTRFET, TRENCH.
TMRTAT.T. rf1ynyTTT, TtAC1KVTT.T, & RFPATR gT*RFFT SEE ATTACHED CONDITIONS
DIMENSION OF INSTALLATION OR REMOVAL
TRF.Ttd'He ti?TT11C_ �+t T1RFP_12f1 7.01m
SIZE OF EXCAVATION, IF NEEDED R
APPROXIMATE TIME WHEN WORK WI'L'L`'BEGIN
APPROXIMATE TIME OF COMPLETION 12�16�99
ESTIMATED CONSTRUCTION COST $ 55.Q00
(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 the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Aclavl
Signature of Applicant or Agent
TTD 81600 AM58, LA AUZNTA. CA.92253 398-5814
Name of Applicant (please print) Business Address Telephone No.
TRAY CONSTR.-RAT SHOUSE 100 W KEYSTONE. BRAWLEY 344-4478
Name of Contractor and Job Foreman Business Address Telephone No.
CA 16333R
Contractor's License No.
City Business License No.
T,TRRRTY MITTTTA7. TB1151020527228
Applicant's Insurance Company Policy Number `
FEES. Subdivision Improvement Permit — Class 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 $ ——
Permit Fee —0
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ --n—
Receipt No. ,
Received by Date
Recorded by
`PERMIT VALIDATION
PERMIT NO. inga
DATE APPROVED 12/9/99.
EXPIRATION DATE 1/28/00
DATE IS UED
By.�
Administrative Authority
Telephone: (619) 777=7075
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