3462t
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
r
Subdivision Improvement Permit — Class I I I
DATE: 5/29/01 I Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 44-996 Adams Street Parcel Map 29288
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Precise, Grading
L '
DESCRIPTION OF CONSTRUCTION Sidewalks, curb & gutter,
storm drain, and paving
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
SEE ATTACHED CONDITIONS
SIZE OF EXCAVATION, IF NEEDED D %j
APPROXIMATE TIME WHEN WORK WILL BEGIN 5130101 /N
APPROXIMATE TIME OF COMPLETION
tit AY 2 9 2001
ESTIMATED CONSTRUCTION COST $ 48.236
(Including removal of all obstruction, materials, and debris, backfilling, com- CITY OF LA OUINTA
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 w/ n work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the ermit and all a plicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Name of Applicant (please print)
re of #pplicant or Agent
Business Address
9-2910
Telephone No.
Six Rids Development 799-2910
Name of Contractor and Job Foreman Business Address Telephone No.
6612.08
Contractor's License No.
City Business License No.
1542858-99— State Fund
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
$ 1447
100
$ 1547
Receipt No.
Received by Date
Recorded by
O
PERMIT VALIDATION
PERMIT NO. 3462
DATE APPROVED 5/29/01 ~
EXPIRATION DATE SLUM
DATE I,HSCJ_ED 511115101
C
By "
—_ Administrative Authority
Telephone: -(760) 777-70751/