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3431NOTE: 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 DATE 04/24/01 LOCATION OF CONSTRUCTION Lot# 30 Tracts 78-710 Bottlebrush Drive Subdivision Improvement Permit— Class III Minor Improvement Permit Class IV (Street address or Description of Location) PURPOSE OF,CONSTRUCTION Install and maintain a one Sketch (attach construction plans if appropriate) 2ncn k1.) domestic water service line DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN USA,# 459604 (see attached special conditions) APPROXIMATE TIME OF COMPLETIONUinety (90) days ESTIMATED CONSTRUCTION COST $ s**1.100.0088* (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 appricant 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 worc 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. of Applicant or Agent COACHELLA VALLEY WATER DISTRICT P.O. Box 1058 Coachella. CA 92236 (760) 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: $ -nn .00 Receipt No. Received by Date Recorded by 34,,1 PERMIT VALIDATION PERMIT NO. #3431 DATE APPROVED 04/27/01 EXPIRATION DATE 05/30/01 DATE ISSUED 04/27/0 J --•... Lindsey Administrative Autho ity Telephone: (760) 777-7075 NOTE: With proper validation this form constitutes an i encr Qachment 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 maims and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS DATE: �� LOCATION OF CONSTRUCTION 'Street adores& or Description of Location) PURPOSE OF CONSTRUCTION 1 "STALL AN)D /Y1A/N/TA/IV A ONE I N C U r 1.1 Dl I ryw DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL— SIZE OF EXCAVATION. IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION W lIU!✓T Y f CIAO) DA YS ESTIMATED CONSTRUCTION COSTS 1IQ0.00 (Including removal of all obstruction. materials. and debris. backfilling. earn• paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit th Subdivision Improvement Permit — Class III Minor Improvement Permit Class IV Sketch (attach construction plans if appropriate) Use Xt .Selz e applicant hereby, agrees to: Inaemnlly. defend and Save the City. ita authariagd agem&, ollicers. representatives NO Miriployees. hamniess from and against env and �. penances. liabilities or 'On resulting from chum or Court action and Mining out of any aCCidfnt, loss or damage to Parton& or prouart� happening or OCtufring as a proaimato result 01 any work undertaken under the Permit grentad pursuant to this application. Notify the Administrative Authority at least lwenty.four 4241 hours in advance of the Brie when work will be started. Comply vinin all aPPlicable City Ordinances. the terms and conditions al the Permit and all MpPlicable rules and regulations of the City o: La Quints and to pay far any t additional replieement necessary as the remit of this wwi6. LAI Signature of Applicant or Agent COACHELLA VALLEY WATER DISTRICT. Name of Applicant (please priP. 0. 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