1279NOTE:`,.
�r,With piopervalidation-
�t6-is form constitutes -an _ \
II+' ',enc o chment,perrriit, -~ —� - CITY OF LA QUINTAL.
---APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE LOQ PERMIT
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: November 5, 1991
LOCATION OF CONSTRUCTION Move equipment
Subdivision Improvement Permit —Class I I I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION move 225 cat excavator Sketch (attach construction Ian if t )
DESCRIPTION OF CONSTRUCTION 10' width, 12' legal height
and length, 25'. Weight 50,000
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF.EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
F s FF. _P'. e
HAUL DATE 11/5/91.
HAUL ROUTE: E. on 111 from Palm
Desert to Jefferson. South on
Jefferson to Ave 54 E. on 54 to
Monroe, South on Monroe to 55
and Monroe.
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, 10 E-pr—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! \II 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.
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $�0
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1279 '
DATE APPROVED 11/5/91
EXPIRATION DATE 11/5/91
DATE ISSUED 11/5/91
By •\
TELEPHONE: (619) 564-2246
Administrative Authority
„
P
Signature of Applicant or Agent
Walton's Backhoe Service 77580 Robin
Palm Desert, CA
345-5212
Name of Applicant (please print)
Business Address
Telephone No. r
Picnni Trucking
Name of Contractor and Job Foreman
Business Address
Telephone No.
On file
On file
Contractor's License No.
City Busiioac nse-05-91 14
i 10.00
On file
LSH
i TgTAL
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
1 279
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $�0
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1279 '
DATE APPROVED 11/5/91
EXPIRATION DATE 11/5/91
DATE ISSUED 11/5/91
By •\
TELEPHONE: (619) 564-2246
Administrative Authority
C- .
r
f
4
/1� ,
aSf
NOTE:
With proper vaiidationi
this form constitutes an
encroachment permit CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
oof- 'f0,1F 0vE:tzS1zf: L-o,AD t�LzlAIT
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, wate -mems..
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS'"
DATE:
LOCATION OF CONSTRUCTION — _%0 KF E QW,,
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV --'
(Street address or Oesaiption of Location) RD
PURPOSE OF CONSTRUCTION a� `J �� CXG19
/U , M7ZU8tch (attach construction plans if a
pPropriatel*
DESCRIPTION OF CONSTRUCTION Wks bq-T,--- — 11-5--- (7l
LP-Qei j h eip h -1- t-2 v -L4-
DIMENSION-OF
L4-
DIMENSIONOF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, bae—*filling, com-
paction and placing permanent resurfacing and/or replacing improvements)
OdIll 4-0m
des er-t-
SVL_-1fh
OA/ /��>G e�sa,.✓
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 terns 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,
of Applicant (please print)
Name of Contractor andMb Foreman
It
Contractor's Lice a Nd\ ,
Signature of Applicant or Agent
c� �7'%gy I tj
Business Address'FIM CA,t e,(- Telephone No.
Business Address Telephone No.
City Business License No.
Applicant's Insurance Company
Policy Number
FEES: Subdivision. Improvement Permit — Class 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 S
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
N°
PERMIT VALIDATION
PERMIT h0.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 664-2246
Administrative Authority