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NOTE:.
With proper validation rt 2
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT --
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)G
ONE TRIP OVERSIZE LOAD PERMIT OF�ti
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.
r Subdivision Improvement Permit — Class I II
DATE: June 18, 1990 Minor Improvement Permit Cla'ss.IV. '
LOCATION OF CONSTRUCTION move equipment
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans.if. appropriate)'
DESCRIPTION OF CONSTRUCTION' 1Dx4R tri.ler HAUL .ROUTE: WASHINGTON TO
CALEE `TAMPICO TO ,DESERT CLUB.
_ DRIVE TO CALLE ESTADO
DIMENSION OF INSTALLATION OR REMOVAL
Y.'
SIZE -OF EXCAVATION, IF NEEDED
rAPPRgXIMATE TIME WHEN WORK WILL BEGIN June 18, 1990
APPROXIMATE TIME OF.COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling,.com.
paction"and placing permanent resurfacing and/or replacing improvements) "
r 1
In consideration of. the granting of, this permit, the applicarit 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 anywork 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.
••igriatiure. of Applicant or Ag�/� '
Scotsman Mf Corp 43180 Sunbuil�st St'. Indi'o,° CA
Name of Applicant '(please print) f Business Address Telephone No. '
Name of Contractor and Job Foreman Business Address Telephone -No.
Contractor's License No. City Business License No.
Partee Ins. Assoc AS 9001652
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs s
Private improvements: 3% of estimated construction costs _
Minor Improvement Permit --Class IV See attached schedule0708
Inspection Fee $ ' PERMIT VALIDATION
Permit Fee n/a 0708
PERMIT NO.
Penalty 6/18/90
Cash Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE 6./1'8/9.0
TOTAL:,' $
DATE ISSUED
Receipt No. ;���
.. By _
Received by Date Administrative Authority
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NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE LOAD PERMIT
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 III
DATE: 'June 18, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION move equipment
f�
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION 10x40 trAiler
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
f APPROXIMATE TIME WHEN WORK WILL BEGIN June 18. 1990
Sketch (attach construction plans if appropriate)
HAUL ROUTE: WASHINGTON TO
CALEE TAMPICO TO DESERT CLUB
DRIVE TO CALLS ESTADO
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(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
t, 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.
Name of Applicant (please print)
Signature of Appl
43180
Business Address
or
st St. Indio, CA
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Partee Ins. Assoc AS 9001652
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs *�
Minor Improvement Permit — Class IV: See attached schedule 0708
O
Inspection Fee $
Permit Fee ' n/a
Penalty
Cash, Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by.
PERMIT VALIDATION
0708
PERMIT NO.
DATE APPROVED. 6/18/90
EXPIRATION DATE 6/18/90
6/18/90
DATE ISSUED',.,
By
Administrative Authority
TELEPHONE: (619) 564-2246