1427NOTE:
With proper validation
this form constitutes an GI -T17^ OF—CA, UINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of F
and other like public works
DATE May 4, 1992
LOCATION OF CONSTRUCTI
c or private curbs, driveways, pavements, sidewal s, parking lots, s wers, water mains
rovements in connection with MINOR IMPROVEME ,TS anclVPPROVIfD SUBDIVISIONS
(Street address or Description of Loc tion) , ..» --_ �-*•_ - - » » rt�y r-» . „�,
PURPOSE OF CONSTRUCTIO
DESCRIPTION OF CONSTRUCTION Pavement profiler
DIM N,,%ON OF INSTALLATION OR REMOVAL 14 wide, 99 6 lon
18 10 height
SIZE OF EXCAVAT , IF NEEDED
Minor Impljovement Perniit Class IV
Sketch (attach colistruction blans if appropriate)
ROUTE: Woudh bound on Washington
To Durango & Herrera.
g
APPROXIMATE TIME'WHEN WORK WILL BEGIN ''-''2�'Z®�g� "
. 11�y 5 s 1992
APPROXIMATE TIME OF COMPLETION PIWT Mgt REQunw,
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 pe Y tfie applican r agrees to:
Indemnify, -defend and save the y, its authorized agents, officers, represent�taves and employees, h rmless from ad against any and all
penalties, liabilities or loss re (ting from .claims or court action and arising out of aany accident, loss or damageo persons or property
happening or occurring as proximate result of .any work undertaken under the perm`iZ granted pursant to this a •plication.
Notify the Administrativ Authority at least twenty-four (24) hours in advance of the tiigr when w i rk will be started.
Comply with all applica le City Ordinances, the terms and conditions of the permit and all a plicabli rules"and regLlations of the City of
�
La Quinta and to pay-fo any additional replacement necessary as the result of this work. I
Signature of Applicant or Al, ent
Standon Co. Inc. P.O. Box 903 Colton, CA 92324 (714) 8 7-2126
Name of Applicant (please print) Business Address T41ephone No.
Pavement Recycling
Name of Contractor and Job Foreman -"B ess Address Tellephone No.
Contractor's License No. City Business License No.
The Jordan Company TCR 14 8� 75
Applicant's Insurance Company PolicyF ' umber `
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 $ PERM T VALIDATION
Permit Fee 10.00 ` 1427
PERMIT NO.
Penalty 5/4/92
Cash Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE 5/5/92
TOTAL: $ 10.00 5/4/92
DATE ISSUED
Receipt No.
By
-Received by Date Administrative Authority.
Recorded by TELEPHONE: (619) 564-2246
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