1623ll�w
NOTE:
With proper validation
,this form constitutes an,
encroachment permit
01
Im
CITY OF ,LA OUINTA'
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 improveme Ats in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
i' 4, Subdivision Improvement Permit — Class III
DATE: 12"'7"42 Minor Improvement Permit Class IV
N;'• LOCATION OF CONSTRUCTION '
• (Street address or Description of Location)
�V` t
PURPOSE OF CONSTRUCTION lova •8gaipmeldt Sketch etch
(attach construction Pl ns if appropriate)
)
" DESCRIPTION OF CONSTRUCTION 245 backhoe haul Routs
from horth of city limits on
.Washington to Tampico and Washington
DIN4ENSIQ9v OF INSTALLATION OR REMOVAL and tatuzn unladen l
„ .-15•t 1 99 111 218,0000
II; SIZE OF EXCAVATION, IF NEEDED haul date"12T7-92
{ APPROXIMATE TIME WHEN WORK WILL BEGIN '
APPROXIMATE TIME OF COMPLETION'
sESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction; materials; and debris, backfilling, com-
hl 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
p ' 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) ho rs i� advance of h time when work will be started.
Comply with all applicable City, Ordinances, the terms and conditi n� of the permi and all plicable rules and regulations of the City of
w La Quinta and to pay -for any additional, replacement necessary as th result of thi work.
r ..
1 .
fIkAk )A
S•gnature of A pf� an or Agent
Cattrac Construction, inc. 15030-slovar, ontana,CA 9233 (909) 355-1146
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address ' Telephone No.
� n
Contractor's License No. City Business License No.
Golden Eagle Ins, CCP194870
16
Applicarit's Insurance Company � Policy Number
FEES:
Subdivision Improvement Permit —Class I I I
Public improvements: 3% of estimated construction costs r
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee . $
Permit Fee • 10
Penalty
-Cash Deposit -Surety Bond
if required
TOTAL: $ 1p'
Receipt No.
Received by
Recorded by
Date
28518CAM 5YdA2_j7-91 i0.00i0
1 623
PERMIT VALIDATION
PERMIT N0. I623
DATE APPROVED _
k:
EXPIRATION DATE
12-4-92
12-7-92
DAT -'E ISSUE 12-7-,,92
RV
Atlministrative Authority
TELEPHONE: (619) 564-2246
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
:;7— 1 n , ,
IBereet address or Oaecriorion of Location)
PURPOSE OF CONSTRUCTIONQ,�, A ► t ,�
Sketch (attach construction I 'f
RIPTION OF CONSTRU' _
--
DI CIOENNSfI11 0
ON OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, iF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
p area s appropriate)
r �
i
R (,144/TS
-10 W46tfwG
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of ail obstruction, materials, and debris, backfilling, corn.
Paction and placing permanent resurfacing and/or replacing improvements)
In co6aideration of the granting of this perrhit the
BMW nit hereby ag�ees to•
Indemnify, defend and save the City,
Penalties,its authorl:ed agents, officers, representative$ and emplo, harmless from and against any and all
haopanin liabilities or lona resulting femployees, claims or court action and arising out of any accident, loss or damage to persona or property
g or ocaurring 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 Clty Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quints and to pay for any additional replacement necaaaary as the result of this work:
Name of Applicant (please print)
Signature
Business Add,
Icant or Agent
PrC0
etas Teleph a
Name of Contractor and Job Foreman
Bus
iness Address Teleehena hin
Contractor's License No.
Applicant's Insurance Company
FEES:
Subdivision Improvement Permit — Class III
P"hlir improvements: '1?4 of 0"i,nptO
ff rn nRirilMiAn neer
V�i� ,",�+��+V6UFnfi�a. �,•,, u, uaunirttru UU11atlU"lun';u"'
Minor Improvement Permit — Class iV: See attached schedule
Inspection Fee $ (7
Permit Fee �!
Penalty
Cash Deponit -Surety Bond
If required
TOTAL: $
Receipt No,
Received by Date
Recorded by
City Business License No,
Policy Number
N�
PERMIT VALIDATION
PERMIT NO, . a P,
DATE APPROVED a— L'i _Q7
EXPIRATION DATE . o 7 — q L
DATE ISSUED �, \
By
Administrative Authority
TELEPHONE; (878) 684.2246
_T 'd 'owi 'monon6isHoo OUNiiUD Zb:ST 26, b0
i