1655NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
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
1/22/93 Subdivision Improvement Permit — Class II I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
WASHINGTON S/0 SIMON
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
TXRNSPORT 623 SCRAPER
DIMENSIONS 12'W -14'2H -65'L
WEIGHT 126,000#, FROM WASHINGTON @
SIMON TO NORTH CITY LIMITS OVER
WASHINGTON
SIZE OF EXCAVATION, IF NEEDED
C9� e '!O�4L�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 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 allr
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 his work.
Signature of Applicant or Agent
CATTRAC CONSTRUCTION 15030 SLOVER AVE FONTANA 92335 (909) 355-1116
Name of Applicant (please print)
CRIST EXCAVATION & GRADING
Name of Contractor and Job Foreman
Business Address Telephone No.
(909) 737-3120
Business Address
Telephone No.
Contractor's License No. City Business License No.
GOLDEN EAGLE INSURANCE CCP194870
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III $ %gCA f41� Rt -22 93-
0
Public improvements: 3% of estimated construction costs v �`
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: $ J ""
Receipt No
Received by
Recorded by
Date
PERMIT VALIDATION
PERMIT NO. /45-150
DATE APPROVED ' a a -R 3
EXPIRATION DATE
DATE ISSUED
By �W
Administrative Authority
TELEPHONE: (619) 564-2246