1642..
NOTE
With proper validation
this form constitutes an
encroachment permit
'1 1
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 �6
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: January 5, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
Move Equipment
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) s
DESCRIPTION OF CONSTRUCTION Haul RRutet South on Washington Street
623 -Scraper, 12 wide, 14'2" high, legal length,
-_ to south of Simon Drive (E1 Miradon
115,000 lbs
Hospital Site). 7
DIMENSION OF INSTALLATION OR REMOVAL
Haul Date: 1/5/92 or 1/6/92
SIZE OF EXCAVATION, IF NEEDED ONE DAY ONLY '
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ .g s C� i 41Q a�A.,—�5_911�p14
(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
e
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 ofthiswork.
Signature of Applic nt or Agent
CatTrac�6nstruction 15030 Glover, Fontana, CA 909-=355-1146
Name of Applicant (please print) Business Address Telephone No.
Same
Name of Contractor. and Job Foreman Business Address Telephone No.
On File-'-, On File
Contractor'sLicense No. City Business License No.
On File. On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
.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 ' 10.00
..
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by. . Date y' -
Recorded by '
1.4:2
PERMIT VALIDATION
1642
PERMIT NO:
DATE APPROVED 1/5/98
EXPIRATION DATE 1/6/98
DATE ISSUED.1/5/92 4
By-- ��
—i
Administrative Authority.-
TELEPHONE:
uthority.TELEPHONE: (619)564-2246
r
� f
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:
LOCATION OF
Wi�
NSTRUCTION
latreet aadress or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
Subdivision Improvement Permit — Class I II
/ Minor Improvement Per it Class IV
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
'� 1 �c`61141 TS
11
APPROXIMATE TIME WHEN WORK WILL BEGIN
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 consideratio.,l of the granting of this per. -nit, 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 permit and all applicable rules and regulations of the City of
La Ouinta and to pay for any additional replacement necessary as the result of this work.
Name of Applicant (please print)
Signature of Ap&3nt or Age -
Business Address Telephone No.
Jame of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicants Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
pllhlic Imnrnvements: 3% ^f.p�timatArf rnn",iwt;nn cnctc.
— ..n rl -Clue i ib- . IU v. a011 I na LcU I:UI I�u UG UUII GUSID
Minor Improvement Permit — Class IV: See attached schedule ` ` U
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
r
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564.2246