1333With proper validation "�• 4 Q �
• this form constitutes an �- CITY. OF LA QUINTA � •�
encroachment permit 4
APPLICATION FOR, PERMIT
' PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)��
SOF
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 I II
DATE: January 15, 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 300 EL Excavator
14'6" high, 12' Wide, -85' length-' Haul Route: Calle Tampico to Washington`
Street South to Durango West to -Ike',
South to Sonora, West Obregon.
-to
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED Haul Date: 1/16/92
APPROXIMATE TIME WHEN WORK.WILL BEGIN(
APPROXIMATE TIME OF COMPLETION s +
ESTIMATED CONSTRUCTION COST $ I
'
(Including removal of all obstruction, materials,,and debris, backfilling, com-
om
paction
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. "
r; ,
Notify they Administrative Authority at least, twenty -tour. (24) hours in advance of the time when 'will be
work 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 buinta 'and to payfor, any additional replacement necessary as the result of this work. L
'
,. Signature of Applicant or Agent';
TARMAC CALIFORNIA .. 'P.O. Box°14050 Palm Desert, CA 92255 •(619) 775-8267
Name of,Applicant (please print) ! Business Address Telephone No.
!'�+
DALTON TRUCKING, -INC.'' 135.60'14hittram Ave. FotiCana, CA. 92335,r (714) 823-0663.
Name of Contractor and Job Foreman' Business Address Telephone No.
On File `' On File
Contractor's License No. City Business License No.
On File - On' File:
Applicant's'lnsurance Company -`. , r Policy Number
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• FEES: Subdivision Improvement Permit — Class III 4 ,
! ::Public improvements: 3%of.estimated construction costs
Private 1 333
improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10.00 PERMIT NO. 1333
Penalty DATE APPROVED 1/15/92
Cash Deposit -Surety Bond
if required EXPIRATION,DATE 1/16/92
TOTAL: $ 10.00 1/ 92
DAT I UED
Receipt No.
BY
Received by Date dministrative Authority
Recorded by TELEPHONE: (619) 564-2246
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