3479NOTE:.
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: June 5, 2001
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Eisenhower & Wanhinszton to Coachella. Washington fram Simon to
Eisenhower
(Street address or Description of Location)
Core Asphalt for Pavement Overlay
PURPOSE OF CONSTRUCTION C Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION C -» *� *- ++ �'�- p—�*- �••�
Moisture & expansion index See attached TRaffic
DIMENSION OF INSTALLATION OR REMOVAL Control Plan
7- 12" diameter holes to be cored & patched
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
-� .' �" T� �a . t t
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 8 n/a
(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 advancerof the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the%pe/rmit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the resulxl of this works �'7 _
Siq11
nnature of Applicant or Agent
Professional Services, Industries 42240VGreenway palm Desert, 92211 (760)341-5790
Name of Applicant (please print)
Business Address
Telephone No.
Juan Nuner/ Briaa Valvronis
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Zurich American g10658047110
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:
$ 0
0
$ 0
Receipt No.
Received by Date
Recorded by
$479
PERMIT VALIDATION
PERMIT NO. 3479
DATE APPROVED 6/5/01
6/6/01
EXPIRATION DATE
6/5/01
DATE ISSUED
By -.
" Administrative Authority
Telephone: (760) 777-7075
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