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1186NOTE: 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 � L a , W Subdivision Improvement Permit— Class III DATE: AUGUST 14. 1991 ` Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION OVERSIZE LOAD PERMIT (Street'address or Description of Location) " PURPOSE OF CONSTRUCTION r Sketch (attach constructs n plans if appropriate) ro riate) k � t DESCRIPTION OF CONSTRUCTION 623 CAT SCRAPER 126255 LB 11'10" WIDE H LEGAL L. LEGAL 3 AXLE TRACTOR 2 AX EISENHOWER 50TH AVE *` TRAILER WASHINGTON TO 111 AUTO CENTER DR. 110 DIMENSION OF INSTALLATION OR REMOVAL r SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN ,, 4 APPROXIMATE TIME OF COMPLETION 1U OS A W.0 �}�g� AL©$i 14_911U.Ot? 1� 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 kl Age $CHWAB SALE. f* 195 R. WARNER RD CHANDLER. AZ 85225 602.899-0088 ' Name of Applicant (please print) Business Address Telephone No. Name of. Contractor and Job Foreman Business Address ;Telephone No: ON'FILE Contractor's License No. City Business License No. �1•T PTI.:' .. 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 10.00 Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by Recorded by $ 10.00 Date PERMIT VALIDATION PERMIT NO. 1186 DATE APPROVED EXPIRATION DATE 8-14-91 8-14-91 DATE ISSUED 8-14-91 By Administrative Authority TELEPHONE: (619) 564-2246 a i i i.� ', �� . � . � . . � �. .• .� i i � i � .. � �� ., .: � �� .. � ... � . r .. ,� r ' � . S, . .. l ' _ +:. i 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 14.y. DATE: /`t wig I �c LOCATION O CONSTRU ION 4e / -7� (Street address or Description of Location) PURPOSE OF CONSTRUCTION ��` �/Z e 49 0 DESCRIPTION OF CONSTRUCTION Subdivision Improvement Permit — Class 111 ^� Minor Improvemen�Permit Class IV —! Sketch (attach construction plans if appropriate) L23 6a1 6-1,"01" DIMENSION OF INSTALLATION OR REMOVAL 126 2,j S L '6 SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN //4 APPROXIMATE TIME OF COMPLETION ` ESTIMATED CON STRUC 110N COST $ (Including removal of all obstruction, materials, and debris, ba-Itfilling, com- -3 A Y- pacton 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 happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this dathis to Persons or property aPPlieetion. 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 Quints and to pay for any additional replacement necessary as the result of this work, ,54,w ,w rl !J Srle Name of Applicant (please print) Signature of ApP1,cant or Agent Business Address le Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. Oh 14 City Business License No. Applicant's Insurance Company Policy Number