1522 (2)T NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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
DATE: 8/26/92
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
eN.
PURPOSE OF CONSTRUCTION i10VA AquiPmOnt
DESCRIPTION OF CONSTRUCTION D-8 Cat. Dozer
3 axle tractor, 2 axle jeev 2 axle.trail.or
DIMENSION OF INSTALLATION OR REMOVAL
I ,,t•;
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
ROUTE: Hwy 111 and Washington to_the
City limits north.
DATE: 8/27/92
APPROXIMATE TIME OF COMPLETION //% LO�t> �S /L � /? �y�'� -
ESTIMATED CONSTRUCTION COST $S�r�
i
(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:
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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 pprmit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the resu of t is work. `.
Signature of 4plicant or Agent
Dalton T>ruckinS. 13560 Whitram Pont=*, CA 92335 (714)823-0663
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman - .1 Business Address Telephone No.
Contractor's License No. City Business License No.
�
/`74-6.
v
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III g� �o ig�q_ Q
Public improvements: 3% of estimated construction costs P05'� CASH S —"TI A1� f 7T9` i0.00 i0
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule 1 522
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: `
10.00
$_ 10.00
Receipt No.
Received by ADate 6,
11,t
Recorded by
PERMIT VALIDATION
PERMIT NO. 1522
DATE APPROVED 8/26/92
EXPIRATION DATE 8/27/92
1 8/' 6/92
D TE ISS, 'ED
Bye iV`�----
}V / Administrative Authority
TELEPHONE: (619) 564-2246
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