1189i:NOTE:
'Witt' 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
8/16/91 Subdivision Improvement Permit — Class 111
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION. Oversize Load
(Street address or Description of Location)
PURPOS T C MOVE EQUIP. Sketch (attach construction plans if appropriate)
IF
DESCRIPTION OF CONSTRUCTION Cat 225 Backhoe, 3 axle
tractor, 2 axle trailer, 12,500 lbs (legal weight)
10 w legal overhang HAUL ROUTE:
DIMENSION OF INSTALLATION OR REMOVAL
10th 6 Eisenhower
SIZE OF EXCAVATION, IF NEEDED East to 50th and
APPROXIMATE TIME WHEN WORK WILL BEGIN` Jefferson
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
s
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
G.L. Gaylor Construction Co. Box 403 Thermal, CA (619) 399-5308
Name of Applicant (please print) Business Address Telephone No.
Larry Gaylor
Name of Contractor and Job Foreman Business Address Telephone No.
524011
Contractor's License No. - City Business License No.
Pan American Undwrwriters 005182 10 3860 8/12/91
Applicant's Insurance Company Policy Number
FEES: Subdivision Imnrovement 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: $ 10.00
Receipt No
Received by
Recorded by
Date
i*05iEAj�0� IAL ib-gii0.00 SO
PERMIT VALIDATION
1189
PERMIT NO.
DATE APPROVED
8/16/91
8/19/91
EXPIRATION DATE
DATE ISSU F D
8/16/91
By
Administrative Authority
TELEPHONE: (619) 564-2246
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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
DATE: 9— /,�,
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRI
3 /11
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement -Permit — Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
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 this work.
Name of Appli&ibt (please print)
Signature of Applicant or Agent
Business Address
Y v=
Telephone No.
Name of Cont4ctor and Jif Foreman Business Address
Telephone No.
Contractor's License. No.
n City Business License No.
Applicant's Insurance Company J
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.
10. 00
$ w'49u
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. %%e 7
DATE APPROVED — f'/6 - q /
EXPIRATION DATE 4?
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246