1303k3 NOTE.:
F ' With proper validation
"this form constitutes an
''='encroachment permit
4
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 worksimprovements in connection with MINORIMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement t Permit —Class III
November 27, 1991
DATE. Minor Improvement Permit Class IV
LOCATION CONSTRUCTION Move Equipment
SII �10 0FC O S RUCTION
J
(Street address or Description of Location)
r 1
623 Scraper
�IPURPOSE OF CONSTRUCTION p Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION HAUL ROUTE:
Monroe to Ave. 52 to Washington.
DIMENSION OF INSTALLATION OR REMOVAL 141H, 101W
IC 110,000 Abs HAUL Date: November 27, 1991
i
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN _
APPROXIMATE TIME OF COMPLETION t
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.
Signature of Applicant or Agent
Piconi Trucking,* 39723 Old Carriage Rd. Murrieta, CA 92362 (714)677-8196
Name of Applicant (please print) Business Address Telephone No.
.Nuevo Engtineeringt, Inc. 79-811 Country Club Dr. Bermuda Dunes, CA 345-1778
Name of Contractor and Job Foreman Business Address Telephone No.
On File On File r
Contractor's License No. City Business.License No.
On File On File
Applicant's Insurance Company Policy Number
`L
R FEES:
Subdivision Improvement Permit — Class III 051825&Ai0 11-27-9i 10
_ Public improvements: 3% of estimated construction costs— i0 _UASH iL 1 �q 30.00
303 Private improvements: 3% of estimated construction c so s ' T. r
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 Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1,101;
DATE APPROVED 11/27/91
11/27/91
EXPIRATION DATE
DATE �u 11127/91
By .
Administrative Authority
TELEPHONE: (619) 564-2246
t 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: November 2$,1991 Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV --
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 6�3 Scraper
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
HAUL ROUTE:
DIMENSION OF INSTALLATION OR REMOVAL 14'H. 10'W Monroe to Ave. 52
110,000 LBS to Washington
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
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, lost 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 1241 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
'-Pi `I�rltc'ki ng.r_:Q7�� t)1 ri!`a
Name of Applicant (please print) Business Address
Telephone No.
Nu evo Engine rinz, Inc. 79—$11 Coijnt ry Cluh D7-RPrmuria n»nP X45 177 3
Name of Contractor and Job Foreman Business Address
Telephone No.
On File
Contractor's License No. On File
City Business License No.
Qn Fi 1 e
Applicants Insurance Company nn F', i 1 A
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
nspection Fee $
'ermit Fee
'enalty
:ash Deposit -Surety Bond
` required
TOTAL: $
leceipt No. '
leceived by Date
lecorded by
N�
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564.2246