3750NOTE
With proper validation
this form constitutes an
N_
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
9-26-02
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S/B Kadiom 150` N10 58
Jafforcan. SC. MudiaL 126' SM Vinta Grande
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Provide Di:-t�cz'loaal oi.gnn for Sketch (attach construction plans if appropriate)
builderz ,arid drweioperc
DESCRIPTION OF CONSTRUCTION 1.1Lt`:11 good algna
See-.ttached condi.tioix
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ASAP
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 r lsuui`t`"o`frthis work.
Signat&e of Applicant or Agent
Bldg Ind. A: zioc. 77--570 Sp.:.ngf ivl.d !«:ro 6E Pa:z Dt�. tF rC, CA 360-2476
Name of Applicant (please print) Business Address Telephone No.
ttt Sig;ta 1550 Gone Auer.. Palm Sprir:G.�, CA 320-3042
Name of Contractor and Job Foreman Business Address Telephone No.
524483
Contractor's License No. City Business License No.
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 fl�
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
$ _0_
Received by Date
Recorded by
3750
PERMIT VALIDATION
PERMIT NO. 3050
DATE APPROVED
9 '6_0
EXPIRATION DATE 2t1
DATE ISSUED -4--
By /�
�11 '1v1 " ,/
Adml�strative Authority
Telephone: (760) 777-7075
SPECIAL CONDITIONS --PERMIT NO. 3750
--- BIA/BEST SIGNS ---
Streets and Parkways shall be kept clean. They shall be completely cleaned at the end each sign
installation if required.
2. Pursuant to Section 14.16.110 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
Permittee shall assume responsibility for repair of any pavement damage to any public or private
street and for any damage to other City streets or facilities as a result of work performed under this
permit.
3. Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
advance warning signs and traffic control shall be installed and maintained in accordance with Cal
Trans Standards or the Work Area Traffic Control Handbook (WATCH Manual). It shall be the
Permittee's responsibility to appropriately detour and barricade this site.
4. Should additional work, materials, or modifications of the work be required in order to meet City
standards, safety requirements, signage requirements, or to fit actual field conditions, the work shall
be performed by the Permittee as directed by and to the satisfaction of the City Engineer at no cost
to the City of La Quinta.
Special Conditions - Permit No. 3750
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