414 (2){ NOTE: ; } r K • r /
With proper validation, • 2
this form constitutes an`�
CITY OF LA' QUINTAL
encroachment permit y �'
'APPLICATION FOR PERMIT
r •. � ' " PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)'OF•��wSw
For the' construction of,public or private curbs, driveways, pavements, sidewalks, parking •lots, sewers, water mains
and' otherlike public works improvements in,connectio6 with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS. +
Subdivision Improvement Permit --Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION washingt•on '-,TheGrove '
(Street address or Description of Location)
PURPOSE OF'CONSTRUCTION Tra:nspO.rt. D7 -DOzer c_Ql*t0 Sketch (attach construction plans if appropriate) •r'
the Grove from outside'City limits ,
DESCRIPTION OF.CON.STRUCTION SEE ATTACHED. RIVERSIDE COUNTY
REGULATIONS see Permit # 410
HAUL ROUTE — Jefferson, Avenue••50
DIMENSION OF INSTALLATION OR REMOVAL _ arid Waashin4t6n Streets
ONE TRIP PERMIT
SIZE OF EXCAVATION, IF NEEDED;
APPROXIMATE TIME WHEN WORK WILL BEGIN f
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Includingremoval of all obstruction, materials, and debris, backfilling, com"
,paction and placing permanent;
resurfacing and/or replacing improvements)
r 1 fir. • • / . - ` e ( ..
In consideration,, of.thegranting 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 -
.i happening or occurring as a proximate re'sult, 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.
i. Signature of, Applicant or Agent
F.J. Stowells, Jr PO Box 1059'.Indio,.CA`92201 774_1359'
Name of Applicant (please print) ` "k Business Address Telephone No. '
same]I k Same, , ' same
rName of Contractor and Job Foremanr "- Business Address : Telephone No..;
- Contractor's License.No. ' " ? ' City Business'License No. ,.
California Farm •`
Applicant's Insu'rance Company Policy Number''
FEES: Subdivision Improvement Permit — Class I I I 0p518 1p =7'S b-i5-89 ' " i0
i8 : ' i� `OTAL i• io.00
+ Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated_66nstruction costs NO 414
Y Minor Improvement Permit — Class IV: See attached schedule ,
•Inspection Fee '' $ —8 PERMIT VALIDATION ,
iPermit Fee ), 10 -00' '
PERMIT NO. 414
;Penalty 6/"15'/89 f
yCash Deposit -Surety Bond DATE APPROVED' } -{
!if.required , t• ' 6/1'5/89
EXPIRATION DATE
r TOTAL:. $' 6. 1 8
9,
DATE ISS
Receipt No.
By
+Received by Date Administrative Authority
IRecotded by TELEPHONE: (619) 564-2246