1410NOTE:
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 and APPROVED SUBDIVISIONS
DATE
April 6, 1992
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I I I
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 Cat 980C Loader
ROUTE: Hishnhower to Washington,
north to City limits.
DIMENSION OAF `�1STALLATION OR REMOVAL Height 15'3" legal f
wddght' 11 0 Weight 60,000
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 92'
APPROXIMATE TIME OF COMPLETION.— 4/6/92
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 nd all applicable rules and regulations of the City of
La Quinta and to
pay for any additional replacement necessary as the result of is xvork. ,• _
re'of Applica
Bonded Rigging & Heavy Transport
325-5523
Name of Applicant (please print) Business Address Telephone No.
M Orlando Gonzales P.O. Box 1774 Rancho Mirage, CA 92270 325-5523
Name of Contractor and Job Foreman Business Address Telephone No.
529442
Contractor's License No. City Business License No.
Aetna. Casualty ACM 21969564 "
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit'— Class III 001 $` CASH$38T�TAL6192 10.0%
Public improvements: 3% of estimated construction costs 4:10,
.
Private improvements: 3% of estimated construction costs ?*, 4�- :I 0 '
Minor Improvement Permit — Class,IV: See attached schedule
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required ?
TOTAL: $ 10.00 a `
'Receipt No. ; •. s . •�,.. � ` .:r
Received by i Date
Recorded by
PERMIT VALIDATION
PERMIT NOiyle?..
DATE
4/6 92
APPROVED /
EXPIRATION DATE 4/6/92.,
DATE.ISS D ?_:: }.4/6/92 ! or
[ `ar Administrative Authority
T TELEPHONE: (619)'564-2246 �'r
tai
--"------------------------------------------------=---T----------------------------------------------'
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
A 2 Subdivision Improvement Permit — Class I I I
DATE: -. Minor Improvement Permit Class IV
LOCATI N OF CONSTRUCTIONS�'`�'`��wE� Sv/v�lL4i9
(Street address or Description of Location) /
PURPOSE OF CONSTRUCTION ��A5/�—"7 ,4& fOyi/�TSketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION -- 'gT 9B0 LoAeE,e
DIMENSION OF INSTALLATION OR REMOVAL /Y"/'Z7"' L=/EC/•¢L (tel/ _ // D'' l•U� ' l� d00 -.V-
SIZE
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 92
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 wKrk. �1
Name of Applicant (please print)
/r
re of Appliont or Agent
%eke_
Business Address Telephone No.
�;v '4� ���E �'�% 92.270 /, I CA
Name of Contractor and Job Foreman'T—
Business Address � Telephone No.
529 ¢2
Contractor's License No. City Business License No.
A-_7 q (.fs41� 7- A e IV
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$ 110
Receipt No.
Received by Date
PERMIT VALIDATION
PERMIT NO
138E
DATE APPROVED
EXPIRATION DATE
DATE ISSUED �— Z
By
Recorded by TELEPHONE: (619) 564-2246
Administrative Authority