1417.�c;'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 and APPROVED SUBDIVISIONS
DATE
April 14, 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 constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION Grinder 10'wide, 84,000 wt.
all else legal.. ROUTE: Washington at Fred Waring
to 52nd.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
MOVE DATE: 4/14/92
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:
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. '
rZA/;4
Signature of.'Applicant or Agent
Tarmac California P.O. Box 14050 Palm Desert, CA 92255 775-8267
Name of Applicant (please print) Business Address Telephone No.
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
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
10.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
i
Receipt No.
Received by
Recorded by
Date
144.7
�v
PERMIT VALIDATION
PERMIT NO. 1417
DATE APPROVED 4/14/92'
,
EXPIRATION DATE 4/14/92
DATE ISSUED 4/14/92
B
Administrative Authority
TELEPHONE: (619) 564-2246
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With prover validation
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o ml< rn CITY OP LA CIUINTA
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APPLICATION . IFC -Pt PERMIT
PLA®LIC WORKS CONS•rRUCT10N (ENCPIOAOMMENT)
For eho emnt ruatlon of publla or privet0ourbs, drlv.wey., P.vemente, .ld.wellu, p.rkinp lot., •.wor•, weer malru
and ether IlketPubliO works Improrrmrntr In eaann.ert 1wlen MINOR IMPROVSMHNTH end APPROVED IDUBOIVISIONS
Ayr Sl 14. 1992 BubdWlelen Improvement Permit — CL_ 111
OATS: Minor Improroment Permit Cl- IV
LOOATION OF CONSTRUCTION
19[rNt adtlr.R or DemnP[Ien Of t.wwt10n1
PURPOSE OF CONSTRUCTION bloyw 23gpd p .tat Sksttdt (atteah oonttrumlen plan. If epproOrlets)
DE RiPTIOI.� OP GONHT RUCTION •r > t.
ea1P� SaRn1. 80/7TH4 WMe1%1RSLon at Hred Wrring
to 52nd,
DIMENSION OF IW67ALLA7I0N OR RHMOVAL
B12H OF EXCAVATION, IF NEEOHO MOVE DAWR. 4/14/92
APPROXIMATH TIME WM HN WORK WILL OEOIN
APPROXIMATE TIME OF COMPLETION
HBTIMATEO CONSTRUCTION COST s
(Inoludlnp »moral of all ebttruatlon, material•, and debrl•, --filling. nem•
Pam= and Pleolne P.rmensm r urfooln. and/or rr Pl..In9 Improvomen e.I
In oo-1-1 -n of .th• 9»ntin9 of —I. Permit, ch. rPPllunt nerebY r9»ee t01
P�aer..nlh .a.reno e1M mva . al<r. It. • «I p.nt., onle.r•. r• .•«n .mr« •nr a n•rmlw • •p•In.t .
nehl«. •blli�iq m ly N In. H m o or . yn e0 .On .no .—In. t e1 .nV ...... �, entl •oP.S'tY
n•PP•nlnp or o r,ne . a wl,r.•a ewult nr wpr4 r.....Men u th• permit sev tW Y tl e�•PPI 0�ilon. n P
Nt.<Ifr th. AdTlnlKra[Ir. AutnorIN hour. , etly.ne• or a time wh.n werM well b .[rrao.
Coen PIY with •11 • Plbrb,e OItY Ordlnen0 the corm .ntl apnonlon.ne t P m . I —.11 •ble rule. •M •eOrl.tlOn..1 rh. CIN of
V Quina .no to p•r 1er •nV eodltlon•1 r• plwement�n•e•.torY a. th. nn." Oi -1. wore.
Nemo of COntraotor and Job Fe»men BurinO•t
Add»« Telephone No.
Ott Lila
On fila
Gentraator'r Livenee No.
Ciay Lloene. No.
On Piles
6193427504
APolloan<•. Inwronoo CempanV
Polloy Number
FEES. Subdlvl•len Improvement Permit — Clam 111
Publlo IMPro nt•1 :I% of .•tlnl.ted P n.truotlon eoe
1 4 1 %
Prlre[e Imprewment•1 ,b 01 ..tlmet•d Oon.truOtlon Cn
Minor Improvement Prrrnit — Clam IV: See atuohod eah,d,l,
I—peoclon Pa. ®
P.rmlt Pae 10.00
PHRMIT VALIDATION
Penalty
PHRMIT NO. --
C•ah Osoa.le-gu reay pond
PATE APPROVED —4 L14 92
11 r.qul»d
EXPIRATION DATe 4/14/92
TOTALS ID <^-^^
R.aeip< No.
OATC IyUHO 4/14/92
R•oaived by Oet.
�$•��G !/ Adml�<ro<IVP Authority
Reoord." by
'T■LHPFiONIB: (!<9) SID4.224ID
TRANSMISSION REPORT
THIS DOCUMENT
WAS SENT
** COUNT
# 1
*** SEND ***
(REDUCED SAMPLE ABOVE)
NO
REMOTE STATION I.D.
START TIME
DURATION
#PAGES
COMMENT
1
6193427504
4-14-92 7:45AM
1'01"
1
TOTAL 0:01,01"
XEROX TELECOPIER 7020