1441l�
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 APPROVEDSUBDIVISIONS
Su6divisioh1th0fevernentyPermit — Class III
rray 18, 1992.
DATE: Minor Improvement Permit Class IV -16 -
LOCATION OF CONSTRUCTION
(Street addressor Description of Location)
PURPOSE OF CONSTRUCTION Grinder. 10' wide. 84,006\.'. Sketch (attach construction plans if appropriate)
pounds, all else legal 1;
DESCRIPTION OF CONSTRUCTION See -above -,Haul Route: Rubio & -Ensehada to 52
and east out of city limits.
DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 5/18/92
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)
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.
Signature of Ap is t 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 File On File
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 10.00 �pJ
Penalty > >�
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.. 1441
DATE APPROVED 5/18/92
EXPIRATION DATE
5/18/92
144T
DATE ISSUED 15/18/92
By
Administrative Authority
TELEPHONE: (619) 564-2246
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