1182NdTE:-,
With proper validation
this form constitutes an
encroachment permit
4
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: 8-13-91
LOCATION OF CONSTRUCTION Mirmy FQILLEMFNT
(street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION 611 RCRAPRR
DIMENSION OF INSTALLATION OR REMOVAL 1GfR, inly
11n,nnn us
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL'BEGIN
ti
I
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
HAUL ROUTE; r
FROM WASHINGTON AND TAMPICO
NIB TO HWY 111 TO CITY LIMITS
HAUL DATE;
8-13-91
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
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
tth�isf work.
Sign'Ature of Applicant or Agent
PICONI TRUCKING 39723 OLD CARRIAGE RD MURRIETA CA 92362 -677-8196
Name of Applicant (please print) Business Address Telephone No.
NUEVO ENGINEERING INC- 79-811 CONXMCLUB DR ARRM1mA DUNKS 145-177A
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE
ON VT1,R
Contractor's License No' City Business License No.
ON ME
Applicant's Insurance Company Policy Number .,
FEES: Subdivision Improvement Permit — Class I I I 10 OVSpi 3p0 810-9110.00 10
Public improvements: 3% of estimated construction costs 1, O
Private improvements: 3% of estimated construction costs U
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 10,00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 8-13-91
8-13-91
EXPIRATION DATE
DA'I E l s 8-13-91
By
Administrative Authority
TELEPHONE: (619) 564-2246
r validation
rtis fit is fr�'rm 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
Au us t 12 19 91 Subdivision Improvement Permit — Class 111
DATE: - Minor Improvement Permit Class IV —�
LOCATION OF CONSTRUCTION
IS'tireet address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION 62� SCRAPER
HAUL ROUTE:
From Washington & Tampico
DIMENSION OF INSTALLATION OR REMOVAL lel' H, 10'W., N/B to Hwy 111 to City Limits
11p�000 LBS
SIZE OF EXCAVATION, IF NEEDED HAUL DATE:
APPROXIMATE TIME WHEN WORK WILL BEGIN 8-13-91
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 end 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 1241 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 Quints and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
..Pi nnni._Tr_11ekin9rw(i Car
Name of Applicant (please print)— f
Business Address Telephone No.
_ N ]PVO .ngi neeri na , In'c 79—i31 1 CoUntr C1 >>h lir RPrmllfia �ll� 1 77�
Name of Contractor and Job Foreman Business Address o
Telephone No.
On File On File
Contractor's License No. / City Business License No.
On Pile
Applicants Insurance Company nn >i b 1 P
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
rtspection Fee $
'ermit Fee
'enalty
:ash Deposit -Surety Bond
` required
TOTAL:
leceipt No.
leceived by Date
lecorded by
N�
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By 1
Administrative Authority
TELEPHONE: (6191 564-2246