1610NOTE:
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: 8oyeabe>r 20, 1992
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION CAT 235 Backhoe From Dune Palms & Westward Ho,
north on Dune Palms, West on Miles
NOrth on � SKI
£;
DIMENSION OF INSTALLATION OR gEM4VAL Loaded on 9 axels line and IMINA1 d ��
Legal heigth, 12 wide, 99 10 overall
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN J 11/23/92
APPROXIMATE TIME OF COMPLETION 11/23/92
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:
J
t
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 permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work. I
.11 r Signature of Applicant ovA'gent
E.L. Yeager Construction, Co„ Inc. P.O. Box 87 Riverside Ca 92502
Name of Applicant (please print) Business Address Telephone No.
(800) 222-5360
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
American International, Co. BE $702162
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
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
10.20
$ 10.00
Date
1610
PERMIT VALIDATION
PERMIT NO. 1610
ti 11/20/92
DATE APPROVED
EXPIRATION DATE
11/23/92
DATE ISSUED 11/20/974
By
dministrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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