1502r
NOTE:- •
,• .
'r•Wlth,proper validation
Irk' 4this form, constitutes am CITY OF LA QUINTA
eencroachment permit`
` APPLICATION FOR PERMIT
••, _PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) ,
For the' construction' of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
s `and other like public works improvements in connection with'MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: July 31, 1992 Minor Improvement Permit Class IV
".,*LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Haul Equipment Sketch (attach construction plans if appropriate)
•.r"DSCRIPTIO OFC I�STI�UCTION �� ROUTE:
Qesngdon and Hwy 111
a ' W_ OVAtl u C 40� baci>`hoe
south to Calle Tampico east
Rondo left to job site.
,,',,DIMENSION OF INSTALLATION OR REMOVAL 12' wide
`•`••SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN- 7/31/92
r ; 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)
wln 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
u' ! 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'foccurring as a proximate result of any work undertaken under the permit granted pursuant to this application. ti •.
Notify•the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
Il' w
t
` Comply with, all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
A. '., La'Quinta and to pay for any additional replacement,necessary as the result of this work.
[T7
:• .' :` ~"`
Signature of Applicant or Agent `- ---�
,,'
•:. _ Staiidon •Co•, INC. `
P.O. Box 903 Colton, CA 92324 (714)877-2126
+' Name of.Applicant'(please print) ;
Business Address Telephone No.
�Gzaxi:,te' Construction 1
Name'of Contractor and Job+Foreman
Business Address Telephone No.
Contractor's License'No.
City Business License No.
t
Cvldan:.al;e tistAxamoe company
TCR 14 87 75
,.._
p • .Applicant's.lns•urance Company `
Policy Number
' .:FFEES: *,Subdivision Improvement Permit
- Class III n�5$
tom io
VAA94373 07
Public improvements:'30/c of estimated construction costs
Private improvements: 3% of estimated
construction costs
s�.''•'• 4'w"Min-6F.lrriprovement Permit — Class
IV: See attached schedule
';Jr
ii.
Inspection Fee' w .. $ '
PERMIT VALIDATION
I,,'.,,. + 11 ' 'i '.10.00 '
Permit Fee.�" -
4
,,t,
'
PERMIT NO. 1502
,. * .
f, Penalty
'•
DATE APPROVED 7/31/92
•`.' Cash Deposit -Surety. Bond 1
• `.; if required
EXPIRATION DATE 7/31/92
., TOTAL $ 10.00
7/31/92
Receipt No.
Received by Date
• Recorded by
I : ,
M
DATE ISS�ED
Administra ' e Authority
TELEPHONE: (619) 564-2246