0118' �{ �T .t � � - ' - ' •� . r , r cif �' '. "' �' w •
.NOTE:-
With
NOTE: With proper validation 2•
this form constitutes an ' • a'
CITY OF LA QUINTA';. ..
encroachment permit a.
„ � .APPLICATION ''FOR PERMIT'.'
a
s
'PUBLIC WORKS CONSTRUCTION, ('ENCROACHMENT)
Al
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
fi
' Subdivision Improvement Permit'- Class +Ill
DATE: Wil 26: 85 ,Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION - 54-845 Aimni.da Alvarado t
(Street address or Descriptiori of Location) ,
PURPOSE OF CONSTRUCTION Driveway Apron Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION r
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF _EXCAVATION,' IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN '
APPROXIMATE TIME OF COMPLETION' +
ESTIMATED. CONSTRUCTION COST $
(Including' removal of all obstruction, materials, and debris, backfilling, com-
paction
om 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 . .,
P,
enalties,- liabilities or loss resulting from claims or'court action and arising out of any accident, loss or damage to persons or property
r -happening or occurring as a proximate result,of any work undertaken under the, permit ranted a
•• g pursuant to this application.
Notify the•.Adminisuative 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.%!,
Si'• nature of Applicant or A-"ent
C1int DHugherty P.O. Box 1420 .. La Quinta,,CA 92'253
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job. Foreman Business Address Telephone No.
• 7
Contractor's License No. - City Business. License No. `-
Applicant's Insurance Company Policy Number;
Public improvements:.3%o of estimated construction costs
Private improvements: 3% of estimated constructiori costs
Minor Improvement Permit - Class IV: See attached schedule'
Inspection Fee $
Permit Fee 20.00 "
Penalty
Cash Deposit -Surety Bond
if,requirecl
TOTAL: $ 20.00'
Receipt No.
Received by Date ti r
''Recorded by '
PERMIT. VALIDATION
PERMIT NO 1358
DATE APPROVED •4-2645.
w/permit
EXPIRATION DATE' ^t_
DATE ISSUED
By
Administrative Authority 7
'TELEPHONE: (619) 564-2246 j '`