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this form constitutes an CITY OF LA QUINTAo
` encroachment permit,
;.�-• APPLICATION- ) FOR PERMIT
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04F PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)c
i � ��OF TE189�
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:October 30, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION EL 300 Excavator. 15' H
111.9" W. 105,000 1 -ba
DIMENSION OF INSTALLATION OR REMOVAL
i.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION
a'"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:
Haul Route: La Fonda & Washington
to Fred Waring and out of City Limits
Haul Date: 10/31/91
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 regulatidns-of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
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Signature of Appli6&r Agent
Tarmac California P.O. Box 14050 Palm Desert, CA 92255 775-8267
Name of Applicant (please print) Business Address Telephone No.
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.
10.00
$ 10.00
Received by Date
PERMIT VALIDATION
PERMIT NO. 1270
DATE APPROVED 10/30/91
EXPIRATION DATE
10/31/91
12.70
DAT I UED 19130/91
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
01=7*1i-30-9 1 W ED 1 4 39 MAS P 0:
NOTi: r
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•ve•a,.r,r oovmrt CITY OF LA CUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONMUCTION IENCROACf'(MENT)
For the aan7uvc 1A of publ,c or prr"U cuetia, dnr•+vY2,
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SIZED EXCAVATION. IF NEFDED %� 6/_
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BEGIN ��
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