1461a
le NOTE:'
With proper validation
this form constitutes an .. CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION '(ENCROACHMENT)
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.v. •V'urt 4. +i w..ryK. yrs ..
,or t. e,. ,construction of public oL�prwate curbs;_ driveways , pa ements;rsidewa(ks;:,par.k.ing �lota�,,sewers ;Vvater'�maihi •
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
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DATE: June 12, 1992
►j LOCATION OF CONSTRUCTION
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(Street address or Description of Location)
PURPOSE OF CONSTRUCTION —623 Scraper 11'10" widA,
0 15'6" high 150.000 lbs.
''DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit —'Class I II
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
ROUTE: 52 at City limits to
Durango and Herrera.
HAUL DATE: 6/13 or 6/15
ONE TRIP ONLY
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,APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
�. pection 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 Applicant or Agent
Tarmac California 775-8267
Name of Applicant (please print) Business Address Telephone No.,
P.O. Box 14050 Palm Desert, CA!92255
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 I I 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 $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 30.00
Date
PERMIT VALIDATION
PERMIT NO. 1461
DATE APPROVED 6/12/92
EXPIRATION DATE 6/15/92
DATE ISbUED 6/12/92
Administra ' e- uthority
TELEPHONE: (619) 564-2246
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