1523V
1
I•� �Y
p. With proper valjdation
this forpi'constitutes an
encroa&ment permit
"'rrr�z
CITY OF LA QUINTA
APPLICATION FOR PERMIT
`PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the"'gonstruction 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
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MnyO, AM124nifflAnt- Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Ax:x*w n—R VAr nnag&r ROUTE: From Hwy 111 and Washington
with blade and rtinner attAghAd _ City limits north.
DIMENSION OF INSTALLATION OR REMOVAL 3 axle tractor
2 axle Jeep 2 axle trailor
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
DATE: 8/27/92
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) a�
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and'sae 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 pe mitt 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 theperm' and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result o this work. \
/1
Signature of Applicant or Agent
r Dalton Truckintz 15560 Whitram Fontana, CA 92335 (714)823-0663
Name of Applicant (please print) Business Address Telephone No.
gName of Contractor and Job Foreman Business Address Telephone No.
On file
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I i0 L`ASIF 7091: i' i0.00
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule 1 2 V y
Inspection, Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
10.00
10.00
Receipt No.
Received by
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
1523
8/26/92
EXPIRATION DATE 8/27/92
DATE ISSUED 8/26/92
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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, sewer:, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: 11
/26 9 g z- Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
.Sketch (attach construction plans if appropriate)
00(,tTe �. FLOwk ��k,ry to
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)
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 perm""d all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of ttfis vJork.
Name of Applicant (please print)
1%Signature of Applicant or Agent (If
Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
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 1389
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO,
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authority