1379r
NOTE:
With proper 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 I I
DATE: f March I0. 1992 `" '
.:. , Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION '''�"'"" �►� , .
(Street address or Description of Location) 'e
PURPOSE OF &STRUCTI N Kamatsu PC 400 Backhoe,
.15 high 12 wide 150,000 b1s.
DESCRIPTION OF CONSTRUCTION See above
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN t
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)
Sketch (attach construction plans if appropriate)
ROUTE: Washington at 111 to 52
to Durango and Eisenhower.
DATE: 3/11/92
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, 1775-8267{
Name of Applicant (please print) Business Address Telephone No.')
P.O. Box 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.
Onf ile
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs QQ
Private improvements: 3% of estimated construction costs?
f
Minor Improvement Permit — Class IV: See attached schedule '
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10.00 1379
PERMIT NO.
Penalty DATE APPROVED 3/10/92
Cash Deposit Surety Bond
if required EXPIRATION DATE 3/1$I09
TOTAL: $ 10.00 DAT D
3/10/92
S
Receipt No.
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
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