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3527NOTE: With proper validation this form constifutes 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 I I I DATE.: 11/1/©1 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Calle estado Between Avenita Bermudas & Desert Club Drive 2001-2002 Village Faire (Street address or Description of Location) PURPOSE OF CONSTRUCTION Villa%te FaireStreet Closing Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Community Event with VpnAars and entsrttaizunent — street closure DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED N/A APPROXIMATE TIME WHEN WORK WILL BEGIN 5 0M — 11 Dm 11-1_ 12-7. 1-4. 2-1. 3-1. 4-5. 2001-2002 ��• f1�"jAGMFLD CO�Di7iD�vS APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (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. Signature of Applicant or Kiner/Goodsell 73--101/11wy 111, Palm Desert, CA 92260 760-773-0290 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. Desert Southwest Ins. Brokers PAS 34988544 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- PERMIT NO Receipt No. Received by Date ,a 3566 PERMIT VALIDATION 3527 DATE APPROVED ,`EXPIRATION DATE 4/5102 DATEEIISSUE I //1/01 By `M W r —It Administrative Authority Recorded by Telephone: (760) 777-7075