1156NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
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
DATE:_ 7/19/91
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE EQUIPMENT Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION D86 CAT BLADE HAUL ROUTE:
15% % 14'6"W % 99110"L
HWY 111 & WASHINGTON TO PARK
DIMENSION OF INSTALLATION OR REMOVAL & TAMPICO.
SIZE OF EXCAVATION, IF NEEDED PILOT CAR REQUIRED FRONT & REAR
APPROXIMATE TIME WHEN WORK WILL BEGIN 7/22/91
APPROXIMATE TIME OF COMPLETION 7/22/91
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
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
CAL PERMITS SAN BERNARDINO 1-800-344-1912
Name of Applicant (please print) Business Address Telephone No.
DALTON TRUCKING 13560 WHTTTRAM FONTANA, CA 714-823-0663
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE ON FILE
Contractor's License No. City Business License No.
ON FILE ON FILE
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
10.00
$ 10.00
Date
5400502K WAF099i0.00 i0
PERMIT VALIDATION
PERMITNO. - 11T&
DATE APPROVED _
EXPIR -I 1 DATE
ATE I SU D
BY
7/19/91
Recorded by 11 TELEPHONE: (619) 564-2246
/91
ministrative Authority
NOTE:
With proper validation
this form constitutes an
encroachment permit 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
DATE: 9"
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
• (Street address or Description of Location)
/ PURPOSE OF CONSTRUCTION 1 '/ D //p - Z�11 / h'/�h7� Sketch (attach
DESCRIP ION OF CONSTR C I
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
construction p1lans If appropriate)
APPROXIMATE TIME WHEN WORK WILL BEGIN
,APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com- �T fZ,� Qi'Z—
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.
Name of Applicant (please print)
Name of Contractor and Job Foreman
Contractor's License No.
Signature of Applicant or Agent .
+ / /-- - /
iness Address
Business Address
Telephone No. f
Telephone No.
City Business License No.
,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
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by. Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
J ,
TELEPHONE: (619) 5642246