0288 (2)W" ith proper validation
this form constitutes an
encroachment permit
0
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
Subdivision Improvement Permit —Class I I I
DATE: November 12, 1987 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78-080 Calle Estado
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION GraiinrT for buildincf Pad .Sketch (attach construction plans if appropriate)
and drive approach 4 i Biu' a .;-• G �� � � E2
DESCRIPTION OF CONSTRUCTION Grading .
• See attached plan
DIMENSION OF INSTALLATION OR REMOVAL 500 Lin. Ft.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 11-14-87
USA No. )
Date Issued.:
APPROXIMATE TIME OF COMPLETION 11-25-87
ESTIMATED CONSTRUCTION COST $ 9,500
(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 result of this work.
Signature of Applicant or Agent
Brian R. Monroe P. O. Box 329, La Quinta 564-2228
Name of Applicant (please print) Business Address Telephone No.
Rick. Johnson Construction
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. .
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
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 277.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
RD -31
$ 277.00
Date
PERMIT VALIDATION
�L
PERMIT NO.
DATE APPROVED /13
Zk Z
EXPIRATION DATE
DATE ISSUEDBy
Administ a Authority
TELEPHONE: (619) 564-2246
ties to tnese monuments shall be tur6shed to the City Engineer prior to the removal of any monuments. This office shall
be notified upon completion of replacement of all survey monuments for proper project clearance.