14691FNOTE: .
With proper validation --
this form constitutes an -CITY OF LA QUINTA
encroachment permit
.11 APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the, construction of public or private cur'bs, 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 — Class III
DATE: June f9. 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
' 1 ;
PURPOSE OF CONSTRUCTION J40VA equipmPnt 'Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Conveyor 11' 10"' wide 85' long
14' high legal wt. ROUTE: Rondo and Tampico to
DIMENSION OF INSTALLATION OR REMOVAL Washington to 52 and
t out of city limits.
1992 ,
SIZE OF EXCAVATION, IF NEEDED DATE! June 19, ,
APPROXIMATE TIME WHEN WORK WILL BEGIN ,
�r APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ ,
+ (Including removal of all obstruction, materials, and debris, backfilling, com-
paction andlacin
p g permanent resurfacing and/or replacing improv �ments)
In consideration of the granting'of this permit, the applicant hereby agrees to: '' ;'
Indemnify,defend and save the Cit its authorized agents, officers, representatives and employees, harmless from'"and a'a`in`st a and all
� Y, 9 P9 Y. �
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.�
y
Comply with all applicable City Ordinances, the terms and conditions of the permit and all•applicable rules and regulations 8f the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
�Sighature'of Applicant or Agent 1.111
Tarmac California 775-8267
Name of Applicant (please print) ' Business Address :Telephone No.
P.O. Box 14050 Palm Desert, d'92255
Name of Contractor and Job Foreman ° Business Address Ueph6ne No.
Onef ile
Contractor's License No. i City Business License No.
Applicant's Insurance Company. Policy Number
s
FEES: Subdivision Improvement Permit — Class - III r
Public improvements: 3% of estimated construction costs 4- .
Private improvements: 3% of estimated construction costs 1,4691.
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
'
' Permit Fee 10.00 '
PERMIT NO. '.1469 '
Penalty
�6/19/92
Cash, Bond DATE APPROVED
if requiredi EXPIRATION DATE 6/19/92
TOTAL: 10.00 .6/19/92
DATE SUED
Receipt No. r"? r
B
Received by Date Administra 1Te—Authority
Recorded by TELEPHONE: (619) 564-2246
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