1292. +. . N
' .
NOT�c
With proper validation
this CITY OF LA QUINTA form constitutes an
-encroachment permit •.
s ti 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
Subdivision Improvement Permit — Class'1II
DATE: Novemb.or�20. 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOV@ Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 235 ftcavator, 11'6" .Wide Haul Route: La Fonda and Rondo to
150;000 lbs; lexal height b Length Washington North to Highland Palms
' " and 1/4 mile onto Highland Palms._
DIMENSION OF INSTALLATION OR REMOVAL
Haul Date: 11/21/91
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, 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
C penalties, liabilities or loss resulting fromfclaims 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 thwpermit and allapplicablerules and regulations of the -City of
La Quinta'and to pay for any additional replacement necessary as the result of this work.
Signature of Applibalt or Agent Tiria Gracey
Tarmac California r P.O. Bol 14050, Pd1m Desert, CA 92255 775-8267
Name of Applicant (please print) Business Address _ . Telephone No.
Name of Contractor and Job Foreman Business Address's Telephone No.
On File On File
Contracto'r's License No. City Business License No.
On File On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111 t
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
c '
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
1'2:92
PERMIT VALIDATION
PERMIT NO. 1292
DATE APPROVED 11/20/91
EXPIRATION DATE - 11/21/91
DATF ISSUED11/go/91
r
By
dministrative Authority
TELEPHONE: (619) 564-2246
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