1367;e NOtE:
tA*".Withy;roper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
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 III
DATE:. February 26, 1992 Minor Improvement Permit Class IV
t
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction olans if annrnnriate)
D SCR P ION OF CONSTRUCTION Trimmer 2 wide, 15 high
oo,�ob lbs.
DIMENSION OF INSTALLATION OR REMOVAL
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 resurfacin and/or re 1—in im rovements)
Route Durango and Bermudas to 52
aad east pf tae City limits.
7
Date 2/26/92.
g p g p
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 Inc. 775-8267
Name of Applicant (please print) Business Address Telephone No.
P.O. Bux 14050 Palm Desert, CA 92255
Name of Contractor and Job Foreman Business Address Telephone No.
On File
Contractor's License No. City Business License No.
On File t
Applicant's Insurance Company Policy Number.
t
FEES: Subdivision Improvement Permit —,Class II 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
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATE
1367
2/26/92
1367
DATE I ED4 2/26/A2
By
Administrative Aut rity
TELEPHONE: (619) 564-2246
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