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1449NOTE: With proper validation this form constitutes an encroachment permit j PUBLIC s t CITY OF LA QUINTA APPLICATION FOR PERMIT WORKS' CONSTRUCTION (ENCROACHMENT) For the construction of public or private curbs, driveways, pavements, sidewalks, parking, lots, sewers, water mains antl'other'Iike public -works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement Permit — Class II I DATE: June 3, 1992 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Grinder c. 10' wide 84,000 lbs all else legal. ROUTE: Washington at Tamp4co to Washington and Fred Waring. DIMENSION OF INSTALLATION OR REMOVAL DATE: June 3, 1992 SIZE OF EXCAVATION, IF NEEDEDi85;� s p R i` OTA b3_9' 00,00 i4 4 APPROXIMATE TIME WHERWORK WILL BEGIN APPROXIMATE TIME OF COMPLETION t` ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris, backfilling, corn I paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit, the applicant hereby agrees to: c , 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 propeety 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 Applicant or Agent, " Tarmac California 775-8268 Name of Applicant (please print) Business Address Telephone No. P.O. Box 14050 Palm Desert, CA Name of Contractor and Job Foreman Business Address Telephone No. On file Contractor's License No. City Business License No. On file Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class II I Public improvements: 3% of estimated construction costs ' Private improvements: 3% of estimated construction costs 1449 Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ Permit Fee Penalty Cash Deposit -Surety Bond ,i if required TOTAL: t.• { 'Receipt No. 100.00 $ 100.00 •' Received by Date Recorded by PERMIT VALIDATION PERMIT NO. 1449 DATE APPROVED 5/3/92 EXPIRATION DATE 5/3/92 DAT 7Ur Bey Administrative Authority TELEPHONE: (619) 564-2246 noA NNVHl 00' 38NVH3 00'OOT Q383QN31 lNnOWV T 00'OOT T ld1Ql T HSV3 OT SC.OZ£000f'.ETOO 00'OOT T '3SIW VT Z6 -EO -90 ESZO OT Z8TS00 VINIIO v-1 30 AM Y t i AWN" 4^da4n6u4,v't+ .�..� k0 o`a�7pijy n----------------- A� � �0 dtl~o`Atli9 aJll:�) 31 V4 oN IO tamed UvaNAIjvv!4X � "VIOL a3ACt964d1/ 3abQ "a'noV N ov03 UA,nS 11100110 %Irv* vwh iq 'V-vutld kp111iCIyVA 111yyJd I — „_--� tA! 3�WAe4 a olnoatpe or,.D6tl,30 tuS ,�I tae � a,y,,,,t f'�^�•�-•�-,. 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