1443a
NOTE:
With proper validation 2
,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
Subdivision Improvement Permit'``—`sClass>Ii`IA,_
DATE: May 19, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Grinder 101 wide. 84,000 lbs
all else .legal
DESCRIPTION OF,CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
ROUTE:. TAMPICO AND WASHINGTON to
111 & RETURN.
DATE: May 19, 1992
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Iricluding 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. f
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.
.75v�il
Signature of Applicant or Agent
Tarmac California 775-8267
Name of Applicant (please print) Business. Address Telephone No..
P.O. Box 14050 Palm Desert, CA 92260
Name of Contractor and Job Foreman Business Address Telephone No.
On File
Contractor's License No.
On File
City Business License No.
Sn File
Applicant's Insurance•Company Policy Number
FEES: Subdivision Improvement Permit — Class l l I
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
Penalty
Cash Deposit -Surety Bond
if required ,
TOTAL: $ 10.00
Receipt No.
Received by
Recorded by
Date
• f
14'4-3`-
PERMIT VALIDATION
PERMIT NO. 1443
DATE APPROVED - 5/19/92
EXPIRATION DATE 5/19/92
DATE 4/11 5/19/•92..
r Administrative 9u_thority
TELEPHON : (619) 564-2246
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