1401t j -
^NOTE:,
With proper 'validation
this -form constitutes an
encroachment 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'arid'APPROVED SUBDIVISIONS
March 26, 1992 Subdivision Improvement Permit— Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of,Location)
PURPOSE OF CONSTRUCTION Move equipment
DESCRIPTION OF'CONSTRUCTION X90
DIMENSION OF INSTALLATION OR REMOVAL Height 15',
Legal, weight 100,000, width 10 .
SIZE OF EXCAVATION, IF'NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
ROUTE: Eisenhower at Mendoza,
east to Washington, north
to Hwy. 111 and,return.on
I ame route, same day only.
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
penalties, liabilities or' loss resulting from claims or court action and arising out of any accident, loss or damage to persons or 'propeity
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 thisjWork.
Signature of Applicant or Agent
Bonded Rigging & Heavy Transport P.O. Box 17 Rancho Mir. , CA 92270 325'5523
Name of Applicant (please print)
ness Address
Telephone No.
Name of Contractor and Job Foreman Business Address • Telephone No.
529442—A 2294
Contractor's License No. City Business License No.
Aetna Casualty NWC 180900
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III 0015 82 405 6�55��(3AL`6i 9
,11
2 i0.�6
Public improvements: 3% of estimated construction costs 1 n
Private improvements: 3% of estimated construction costs 14
1 4G1.
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 10.00 PERMIT VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT NO.. 1401;
DATE APPROVED 3/26/92
EXPIRATION DATE
3/26/92'
DATE ISSUE 3/26/92
By -�
-r Administrative Authority
TELEPHONE: (619) 564-2246
I
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
�17ir!(1 p Subdivision Improvement Permit — Class 111
DgTE:
� _ _ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION L l Sv�✓1-�v - @ yl�✓ 0 a ��
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION L- 280
Sketch (attach construction plans if appropriate)
DIMENSION OF INSTALLATION OR REMOVAL S a �_iL Gv = i00,000'/-
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)
GIST io r„uySf/i�CTo,�/ /vo/�771 To
Hwy
Af
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 Quinte and to pay for any additional replacement necessary as the result of thi work.
Q Si Lure of Applica t or Agent
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
-6-2-944,2 -/4
Business Address Telephone No.
Contractor's License No. City Business License No.
dreoTtif Cwszt,467_y C11I�bO 0
Applicant's Insurance Company Policy Number
FEES: 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 / y
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ a
Receipt No.
Received by Date
Recorded by
PERMIT NO.
1266
PERMIT VALIDATION
1 4/T�/
DATE APPROVED 3-2(p '- Q 2 -
EXPIRATION
EXPIRATION DATE �' q `-
DATE ISSUED
By
< Administrative Authority
TELEPHONE: (619) 564-2246