1512NOTE:
With proper validation
L this form constitutes an
)" encroachment permit
4-1
CITY OF LA, QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE LOAD PERMIT
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— Class III
DATE: August 12, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION La Quinta High School on Dune Palms Rd.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move equipment
DESCRIPTION OF CONSTRUCTION 10' 0' wide, 48'0' length
14'0" high
DIMENSION OF INSTALLATION OR REMOVAL Between 6:00 AM
and 8:00 AM on 8/13/92
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 8/13/92
Sketch (attach construction plans if appropriate)
HAUL ROUTE: Youth on Washington,
east on Miles, south
on Dune Palms.
APPROXIMATE TIME OF COMPLETION 8/13/92
ESTIMATED CONSTRUCTION COST $
(Including 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
I
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 ptrmit and all applicable ru
La Quinta and to pay for any additional replacement necessary as the res t of ,his ork.
Signe ure of Applic nt or AAA t
Drive
1958
, CA
ulations of the City of
Name of Applicant (please print) B mess Address Telephone No.
(800) 777-5906
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
National Union Fine Ins, Co. 1993189
Applicant's Insurance Company Policy Number TAR tiA�H T� �~ ` 1U,Q0 i0
FEES: Subdivision Improvement Permit — Class 111
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
19.00
W
Date
PERMIT VALIDATION
PERMIT NO. 1512
DATE APPROVED 8/12/92
EXPIRATION DATE 8/13/92
DATE ISS ED 8/12/92
By
h ministrative Authority
TELEPHONE: (619) 564-2246
4 r 4Vr 9x1 1"092mOE O15:5LiD oW00DLvAND CA µpmm +
TEL NO:916 666 5874 #231 P02 —
iOV4JV I 1^e1VVV6A1I60 Wr% ...
NOTE:
Whh propos velhletion t
this Dorm coftnln
CITY OF LA OUINTA
ehwoaehmant pGFMit ermll
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (9NCROACHMENT)
b N E Ttil P w/ e.251ZC LO A A
@0
For the agnstMatiorf of "id ar private eurbs, drivowevs, pavements, tldewelke, parking IOU, uWars. water inf>ire
and other like bubilo works Improwmants In ooraactlon with MINOR IMPROVRMINTB and APPROVED NUSDIVISIONS
tubdlatriolt Im"voeClue III
Pond — ClIII
✓OATS+ Minor Improtfem m Ptm it Clttu IV'
r,—LOCATION OF CONSTRUCTION
linen a izim" W Dewrlpdan of Lawtjwm
PURPOSE OF CONURUCTION
--'6F.9CRIPTION OF CONIiTRUCTION
u e}--DIMENSIONgOF IN AL IP0 lit. REM
t�rwG41 $116 OF EXCAVATION, III NlEDlI)
D u IJF-
Slisuh (ettaih OMV111@tli6 alone If epor+yorlatr)
NWW4:5R1 fJGTD_ N VA sr o►J
M . LLS S —z� of t t t+ o IJ DUPE P*L 's
—7VM0XIMATE TIMI WHEN WRK WILL BEGIN
"�►i PROXIMATE TIME OF COMPLETION 3-92
E1TIMAT10 CONSTRUCTION COST I
(Induding removal of alt obatruttion, Materiels, and debris, backfilling, com•
pRtfbn and plednq permanent rssurfadnq and/or roplWN ImprpvqlM@nV)
In eavtdderodon At the graritlha of this permit, the 8001 osnt hereby Agree to
Indamnlfy. •dstsnd ens ea» the City, Ifl tudlerlaod wenu, oNken, ropresei+tedwee and amplovm, hanmleu I mn sno WhW Inv and ail
tbnalwea. Ilebllhla or lar r UMAO r+arm sioume or eourt quer Emil owelrit out or oily eMseefn. Ioet or dilmeae !a aHOM M 0M -;1Y
he�p�an►ne 01' OM"'na dIo a PMX'ff' n ,pule of any WWII undenewan under the pnMt a,VW pdnaamt to tnu aWlIetlaw.
Notify the AdMITIMI'll w Authority R Ing trlanly4oyr l7rrl haws in wirer" of dy tis n, FAM ,mart will in !1ln d,
Ce .0y with ail Womble Oily ofellilift . the Tonin and tomsiona of the permit ane eel epptluahta tutee pid raaulKNne of ae City N
LA amino end to pay for any eddltlantl rep1e0"naM nmtwv as the rs{eIt of this work.
btgnature Ot Appliftnt of AOattt
Away-_1958 s Lane Woodland CA 95776
4e111114of Applicant (plum print) Business Address, ToloOme No..
SQQ 222-52Q6
Name of Connector grid jots Fdhman dullness Addrue Telephone No.
COritfaotor'e Ldmm No. City &Wma Llaertea Na.
Fire Ins. Co. 1993189
Aollunt•s immune Company /alloy NIMMISIt
►BE11 subdivisiof4 IfnptOYsmint Ptrrmtt —Class I11
Publk Irttpr®vaflt�fte; 9tX of aetlsneted oenetrualen toete ,� 1,
PrNaU Irnpremrum"WT'3%of eattfmtad aonurustlen poets
Minor Im roramtht Parfnit — Class IVs gee attached schedule
IMpeotien ' � t
VALIDATION
Pefmlt ►w /s/ Z
penalty Post•Il 1t nd fax transmittal memo 1671 #0 PeBia 0,_ _- _... _..... _...- _ . .
Cart Depot To #Eb popqrn
It r"ulrad
Co.
Tt `" LA.
Receipt No
rlawired b� �
r IM 17 Adiftinlstrativo Authority