3117i NOTE:
With propetvalidation o4 2
this form constitutes an CITY OF LA QUINTA
encroachment permit .
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
DATE:1/11/00
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78730 BOTTLEBRUSR DR.. I.QT 2A
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION INSTALL' & MAINTAIN A 1"
DOMESTIC WATER LINE
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE'OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1113100
Sketch (attach construction plans if appropriate)
SEE ATTACHED CONDITIONS
APPROXIMATE TIME OF COMPLETION 90 DAYS
ESTIMATED CONSTRUCTION COST $ 1,100.00
(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) h'ours• in advance of the time when work will be started.
Comply with all applicable City. Ordinances, the terms and conditions of the permit an� 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.
Signature of Applicant or Agen
CVWD P.O.BOX 1058, COACHELLA, CA.92236 398-2651
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicant'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,
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond.
if required
TOTAL:
Receipt No.
—0—
$
Received by Date
117
PERMIT VALIDATION
PERMIT NO. 3117
DATE APPROVED 1/11/00
EXPIRATION DATE 3/15/00
DATE SS ED 1/II/00
By _
V Administrative Authority
Recorded by
Telephone: (760) 777-7075
�S I
NOTE
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QVINTA
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:- � �� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 2 - 7.3 D &6
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION I N-STALL ANh InA/NTA//V A
DNE I NC1U C 1'9 DOMES7-1L' LU ATir4-7FaVICE LJAl&
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN /- AS- 00
APPROXIMATE TIME OF COMPLETION N/NF-7y 19,0) DAYS
ESTIMATED CONSTRUCTION COSTS 1 IQ0.00
(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:
IF 7"4t> 10"
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees. harmless from and against any and is.
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or Carnage to persons or provertN
happening or occurrino as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four 124) 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 o:
La Quinta ano to pay for any additional replacement necessary as the result of this w
Signature of pplicant or Age
COACHELLA VALLEY WATER DISTRICT. P. 0. Box 1058 COACHEL , A. 92236 398-2651
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
Itt 1 p0 City Business License No.
3�ir7 00
Applicant's Insurance Company I `� ei Policy Numoer
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