1328OOTE:y
6ith 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
Subdivision Improvement Permit — Class II I
DATE: January 9, 1992' Minor Improvement Permit Class IV,
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Grinder. 10' wide. t Haul Route: La Fonda and Washington
130.000 lbs: all else legal to Bermudas and. Durango
DIMENSION OF INSTALLATION OR REMOVAL 'Maul Date: 1/10/92
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, 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
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 ti On File
Contractor's License No. r City Business License No.
On File On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit - Class 111 005182 10 6695 01-09-92 i0
10• CASH i TOTAL 1 150.00
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 13,28
Minor Improvement Permit — Class IV: See attached schedule f,
Inspection Fee
Permit, Feel'
r
Penalty
` Cash Deposit -Surety Bond
if required
TOTAL:
150.00
$ 150.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1328
DATE APPROVED 1/9/92
EXPIRATION DATE 1/10/92
DATE ISSUED 1/9/92
By.�•'�iI'�/1
Administrative Authority
TELEPHONE: (619) 564-2246
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t"taose+«s rt pa,nrt CITY OF LA QUINTA
APPLtCATION FOR PERMIT
PUSUC WORKS CONSTRUCTION 1ENCROAC8meWp
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DIMENSION OF INSTA, 1' OR REMOVAL �G� 51�
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME YmEH YORK WILL $EGIN
APPP,OXIMATE TIME OF COMPLETION
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