4001NOTE:
'Withrprpoper validation,_,
form -an
,y
ennccrboachment permit
fit: 12Z 2003
. . Imo,..-r=:-..:...r.....�...---'�
CITY OF LA QUINTA
CITY OF LA QUINTA
APPLICATION FOR PERMIT
IC WORKS CONSTRUCTION (ENCROACHMENT) ;
FINANCE CEP7�
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
DATE: September 30, 2003 Minor Improvement Permit Class.IV X
LOCATION OF CONSTRUCTION Tranct ' 31b81,' Coral Mountain. Betaeen'Madison and Monroe and
Avenue,58 and Avenue till '
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 11and clearitiA Sketch (attach.construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION clearing and grubinp *€sea attdched special conditionsit
Plan Check 03128 & 03039
DIMENSION OF' INSTALLATION OR REMOVAL 1550 acree
Stagy 1: For inobili.:zation.,
pro-vateieo - Cie€cri ig & , tubing
SIZE'OF EXCAVATION, IF NEEDED PM10 �39 refired:
No rough grading until gra�ding
APPROXIMATE TIME WHEN WORK WILL BEGIN October '1. 2003 plane acre approved. dl5 ..ii
4-6 tm,„
.APPROXIMATE TIME OF COMPLETION tdarch la 2004���� w�
ESTIMATED CONSTRUCTION COST $ 182..000.00
(.Including removal of all obstruction, materials, and debris, backfilling; com-
paction and placing permanent resurfacing and/or rep(acirig 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 asa 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 Quihta and to pay for any additional replacement necessary as the result Qoff this work. t
Signature of Applicant or Agent
IvoaLuxt mar (7.60) 4089106 ;
T.$. Desert Develooment P.O. Box ,1716, La Quinth, CA 92253' (760)'71-4941:
Name of Applicant (please print) Business Address Telephone No.:
Demo Uolimited, lue. 81750 Ave'oue' 50,. Indio, . CA (800}: 337=5884
,.,Name of,Conti•actor and Job Foreman Business Address Telephone No.
473328 01546'.
Contractor's'License No. City Business License No.
1atiOnal Union Dire Znouraince •Cotaparty GL5440206RA
Applicant's Insurance Company Policy Number.
FEES: Subdivision Improvement Permit — Class.11l
Public improvements: 3% of 'estimated construction costs Ell HTFIRED.
Private improvements: 3% of estimated construction costs
Minor. Improvement Permit — Class IV: See attached schedule $ft 00 �(�
Inspection Fee $ 5,460.0.0 PERMIT VALIDATION
Permit Fee 100,00. 4001
PERMIT NO.
Penalty. ,
Cash Deposit -Surety Bond
if repuired
TOTAL': $ 5 a $60.00
'Receipt No..
Received'by Date
Recorded by
DATEAPPROVED Septet*er 30, 2003
EXPIRATION DATE September 30, . 2004
DATE ISSUED' '
By
• Administrative Authority
Telephone: (760) 777-7075 .
2