7077T4ht 4 4 Q"
ENCROACHMENT PERMIT
PUBLIC WORKS CONSTRUCTION
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sei
works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
Finance Revenue Code E-1
P O
CITY OF LA
Subdivision Improvement Permit - Class III
Minor Improvement Permit Class IV
DATE:March 30, 2007
LOCATION OF CONSTRUCTION (Street address or Description): Washington St. between Highway 111 & Fred Waring Dr.
PURPOSE OF CONSTRUCTION: Indian Wells Arts Festival
DESCRIPTION OF CONSTRUCTION: Temporary directional signage
DIMENSION OFINSTALLATION OR REMOVAL: N / A
blic
APPROXIMATE'TIME WHEN WORK WILL BEGIN:March 30, 2007 TIME OF COMPLETION:April 2, 2007
ESTIMATED CONSTRUCTION COST: $0 (Including removal of all obstruction, materials, and debris, backfilling, compaction and
placing permanent resurfacing and/or replacing improvements)
COMMENTS:
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 at (760) 777-
7075.
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 licant or Agent
Diane Funk Enterprises - Kelly Halbeisen P.O. Box 62, Palm Desert, CA 92261 (760) 346-0042 (760) 200-8400
Name of Applicant (please print) . Business Address Telephone No.
Name of Contractor and Job Foreman
Contractor's License No.
Business Address
TBA
City Business License No.
TBA TBA
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit - Class III
Minor Improvement Permit - Class IV
Inspection Fee
Permit Fee
As -Built Deposit
Cash Deposit -Surety Bond,
if required
TOTAL
$0
$100.00
$0
$0
$100.00
Telephone No.
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
See attached schedule
PERMIT NO.%O%%
DATE APPROVED: *t. 50� Z6b'7
EXPIR DA0 'ZOd -7
BY:`�
Administrative Authority
P.
32
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PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date:
Tract No: .Project Name:
Vicinity:
se of Construction (Ex: Rough Gra
'-Sara—n/► ��.2c�-f.-8,r`c�l
Mite Street
Description of Construction (Ex: See Plan Set No. 01234)
Dimension of Installation or Removal:
Approximate Construction Start Date: A4*4. To 2o0 --I-
Approximate Construction Completion Date: A-e Zt 2eP'O 7
Estimated Construction Cost: $
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back -filling, compaction and
Placing permanent, resurfacing and or replacing'improvements
Contact Name: Ct,(,� - `' ,.� Phone Number: 3'l to 004Z
Name of Applicant/O er: t �r
Applicant Address: 67. D , b / 7� cd M
Applicant Telephone Number:
Name of Contractor:
Contractor Address:
Contractor Telephone Number:
Contractor State License Number.
Contractor City Business License Number:
A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED -4
Applicant or Contractor General Liability Insurance Company:
Applicant or Contractor General Liability Insurance Policy Number:
Office Use Only:
Inspection Fee:
Pennrt Fee:
As -Bull 1
Deposit: C(5
Dust Control
Deposit:
Credit �=Amount-_ ---_
TOTAL FEE DUE: 'rf / OD
Office Use Only:
Assigned Pemrit Number.
Approval Date: ( /
Expiration
Date:
Issue
Date:
y 411,
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