1409--------------------
a.
NOTE:
With proper validation 2
O
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 66nnection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
�Y Subdivision Improvement Permit — Class III
DATE: _
4/3/92"'`�'" `9.r�r �� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment
DESCRIPTION OF CONSTRUCTION 623 Cat Scraper, 11110"
isiitk Wide, 15'4" High, 120,000 lbs, Legal Length
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
Haul Route: Washington from Fred
Waring to 52nd.
Haul Date: 4/6/92
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 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.
em'
Signature of Ap)ajant or Aged -JL) a -� 5 p Li
Tarmac California P.O. Box 14050 Palm Desert, CA 92255 775-8267
Name of Applicant (please print) Business Address Telephone No.
Same
Name of Contractor and Job Foreman Business Address Telephone No.
On File On File
Contractor's License No. City Business License No.
On File , On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs {�
Private improvements: 3%,of estimated construction costs 1409-
ti
Minor Improvement Permit — Class IV: See attached schedule
f
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10.00 1409
PERMIT NO.
Penalty DATE APPROVED - L4/3/92
Cash Deposit -Surety Bond
if required EXPIRATION DATE - 4/6/9.2
TOTAL: $ -10.00 DT ISSUED ,�✓92
Receipt No.
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
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