1378`dam
1`'VUith proper validation
_.::.tliis'form constitutes an
rencroachment 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
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DATE: March 9. 1992
'LOCATION OF CONSTRUCTION
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
,PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION D-6 Dozer, 101 High Haul Route: Avenue 50 at Park to
11"10 Wide, 70,000 lbs. :Washington Street North to Del Webb
DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 3/10/92
'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:
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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.
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Notify'.the AdmiAistrative 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
Nuevo`Engineering 79-811 Country Club Drive Bermuda Dunes, CA 345-1778
Name of Applicant (please print) Business Address Telephone No.
,'Piconi Trucking 39-723 Old Carriage Rd., Murrieta, CA 92362 (714) 677-8196
Name of Contractor and Job Foreman,- Business Address Telephone No.
On, File On File
Contractor's License No." City Business License No.
On'F'ile .. On File" _ 4
Applicant's;Insurance Company Policy Number
FEES:' Subdivision Improvement Permit — Class 111 005182 10 8232 03-09-92 10
CASH 1 TOTAL i 50.40
Public'improvements: 3% of estimated construction costs QQ 'y
'Private improvements: 3% of estimated construction costs 1 1 378
Minor.Improvement Permit - Class IV: See attached schedule
Inspection Fee ' ' $ II PERMIT VALIDATION
Permit:Fee i 10.00
.- I•
Penalty
Cash Deposit-SuretyIBond
if required
TOTAL
Receipt No
Received by
Recorded by
$ )6,(3c)
Date
PERMIT NO. 1 X78
DATE APPROVED 3/9/92
EXPIRATION DATE 3/10/92
DAT ISSUED 3%9/92
By
Administrative Authority'
TELEPHONE: (619) 564-2246 4"
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