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1275)AMOTE: _With proper validation this form constitutes an r 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:-ftSpkgx November 1, 1991 LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION ti DESCRIPTION OF CONSTRUCTION EL 300 Excavator, 11'2 Wide x 15' High, Greet WT DIMENSION OF INSTALLATION OR REMOVAL Subdivision Improvement Permit — Class II I Minor Improvement Permit Class IV Sketch (attach construction plans if appropriate) Haul Route: Fred Waring.,at Washington to La Fonda and Washington Haul Date: ' 11/04/91 SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN i80518 2S 0i 53�7AiOfriSL i 0.0 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 th`e'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 Applica or 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 III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs `, 1275, Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ Permit Fee loam /So , 0 O Penalty Cash Deposit -Surety Bond if required TOTAL_. _ -$ SO, O© _ Receipt No. Received by a Recorded by I. 1��r Date PERMIT VALIDATION PERMIT NO. 1275 4 DATE APPROVED 11/ 1/ 91 EXPIRATION DATE "11/4/91 DATE ISSUED 11/4/91 By :. Administrative Authority TELEPHONE: (619)..564-2246-• 14 1 .f Date PERMIT VALIDATION PERMIT NO. 1275 4 DATE APPROVED 11/ 1/ 91 EXPIRATION DATE "11/4/91 DATE ISSUED 11/4/91 By :. Administrative Authority TELEPHONE: (619)..564-2246-• 14 1 .f NOTE: With (roar validreen Cho form mrntrWass an enoosen"my Dorm, CITY OF LA QUINTA APPLICATION. FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) and othther like tttulK For mnrt",c of public or prrvtta euros, drlvawsys. paverrre"U. Sidewalks, partcinq IOL. aewon, watts wales imarnvwnarm in eonnemon with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONSlslai DATE:_ L/ / r / Subdivision Improvt+nrnt Parmrt � Gaw 111 Minor Imprawwro t panhR CUM IV LOCATION OF CONSTRUCTION lS~ scone or Qmscreii3m. a LaQeonr PURPOSE OF CONSTRUCTION _ 0 ,R ION QF NSTRU 0 — DIMENSION OF INSTALLATION OR REMOVAL Sketch (attach_ CcJ"Vuczion plans if apptaphtoio 10I oc f n SIZE OF EXATION. IF NEEDED —�L� G2 APPROXIMATE TIME WHEN WORK MILL BEGIN la�o APPROXIMATE TIME OF COMPLETION Xrw'l. ESTIMATED CONSTRUCTION COST S (Intlutlirrq nrrroves of all ohttr---n, mrtarrals. and debris, ba•ttilli / paccon and placing fir^ 9 Derrrrerrsnt retta•taae+q and/or rapbdnq improvemwttsl ` •� — . In Consideration of'.the girantinq of the permit• the applicant hervov agrm to: "4"-"v. Oet— ewe aM the arv. m avafeneee demo. officm. reorasnvtrrr, are wndrove••. ham"*"; from ewe opwimi arry as ea . O•rr•irwr' 40Oi1nim or ion riewowq ficin Deme or eosin apron ane snum art a acv aecasm. Ica r oany�e to Germ «mere► nr�n"re r a"im" e r e sudamen worn of any worn urrearasan Brew sna sioerrt yeenrao wraum to a+r aaaoaen. NVIONcommtwrt�" wullt re Arrvwwvty at Ism own '40ur 1241 Irwn rr ad _ a sM trine www+ arors ••rrl a etamic ece+oere GN CMVUP ,. the tarrro &no Bone.tone of er• ld Quinn arra to esv kv aannn ane all aaw Rad• wire ane. w'r' aoenv,,. r•eraerr+.sm nrvaory •r rn• Hent ei n wore. !sew<atere M M CJty W 4, �G S�"lure of Aoplront or Agent Ne or Aoonon please onntl C r rM Adtlrass i elephant No. Name or Contractor and Jon ore n 111112 Business Address TSleo+rorr N d!2 Contractor s L.cense No. - �/ Gtv Busineu License No. ADDhCant'I Inturenpt Co,.r,�ry . Policy Numoer FEES: S"bmvnion Imdro.arryrrt Perrr,rt CLU 111 PublicrrrrWora"--: 3% of araer-1 a mnrtructlon corn Privets improve ono: 3% Of Mrmted mnrtrumon tern Minor Imorovement Permit _ Clan IV: See aftavvd schedule N� • rrrstwcUOn ►rr S ' ptrm,tFrr I PERMIT VALIDATION Denalty 'c_ RMIT ';0. C'eoh oepwst•Surery Bono DATE APPROVED if raoulred _ TOTAL: EXPIRATION DATE Race of No. DATE ISSUED Reed by Data By Reoorpb ov 4, Admmauvvve Aythorny TELEPHONE 16tp1 564 -Mb