1327,r^ x
NOTE,'
.,With pr&envaliclation
this form constitutes an `' •,'
encroachment permit
w- e
i CITY, 4OF 'LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
Forthe r 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: ' January 8, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION '
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTi6N'OF CONSTRUCTION 265 Paver, 11'6" wide, Haul Route: La Fonda and Washffingto.n
84.000`lbs: All else leixal. North on Washington to Fred Waring
East to Adams.
DIMENSION OF INSTALLATION OR REMOVAL
Haul Date: 1/8/92 or 1/9/92; 1 day,only.
SIZE OF EXCAVATION,•IF NEEDED s• '•
APPROXIMATE -TIME WHEN WORK WILL BEGIN
-APPROXIMATE TIME OF'COMPLETION
i�7 ESTIMATED CONSTRUCTION COST $
y ti ,(Includingjemoval 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
I�r La Quinta and to.pay for: any additional replacement necessary as the result of s work.
s Signature of Applicant or Agent
A
(TARMAC CALIFORNIA P.O. Box 14050 Pa1.mmDesett, CA 92255 775-8267
Name of Applicant'(please print) Business Address �. Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
h On File imi�" On File
Contractor's License No. City Business License No.
On File On File '
Applicant's Insurance Company Policy Number
FEES: Subdivision Imorovement Permit — Class I 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 $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
.Recorded by '
132.1'
PERMIT VALIDATION
PERMIT NO. 1327
DATE APPROVED 1/8/92
EXPIRATION DATE - 1/9/92
DATE ISSUED A_/8/92
By
Administrative Authority
TELEPHONE: (619)564-2246
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