1356NOTE: `
With proper validation
this form constitutes.an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION F(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: RRMTKIM February 10, 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 Paver,. 1116" wide, Green
Weight, Legal'Height
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Haul Route: Washington at Fred Waring
to Highland Palms and Cameo Palms
Haul Date: 2/10/92
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
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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.
t
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.
n
t,*
Signature o 4,plicant of A e t
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.
Z
On. Pile On File
Contractor's License -No. City Business License No.
On File On File -
Applicant's Insurance CompanyPolicy Number
t,.LLFEES: 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
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond .
if required
TOTAL: $ 10.00
Receipt No
Received by, ' Date
Recorded by
'. 356
.PERMIT VALIDATION
PERMIT NO. 1356•."
DATE APPROVED 2/ 10/92
EXPIRATION DATE 2/1:1/92
DATE ISSUED 2/11/92
By
Administrative Authority
TELEPHONE: (619) 54-2246
F E E— �A 0— 9 2
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CITY OF LA OUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION 1ENCROACHMENT1
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