1773NOTE:
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
Subdivision Improvement Permit — Class III
DATE: bZ��i�� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION The Quarry
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Oversize Load Permit Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTtION Cat 627E Tracto scraper Route: Monroe $t to 58th west
Rt—legal, Width 1106, Vength 104' to Keller Pit Rt
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6/24/93
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 -fou; (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the pe�,and al applicable rules nd�lations of the City of
La Quinta and to pay for any additional replacement necessary as the result�of jhis wo5 ..I /
re of Applicant or
Daily Express POSox 94805 Oklahoma / 800) 344-1912
Name of Applicant (please print) Business Address Telephone No.
Diana
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 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
10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Arm WA, M. 409
1 TT3
PERMIT VALIDATION
PERMIT NO. 1773
DATE APPROVED
6/23/93
EXPIRATION DATE 6/24/93
DATE ISSUED 6/2//93
By
f Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
}.t c�
a �
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
y .
Subdivision Improvement Permit - Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CON TRUCTION - 0 IJ 669 / Z4 L-&^ 0 Sketch (attach construction plans if appropriate)
DES RIPTION OF CONSTRUCTION 7 /r- �L C"4 %
ffACf'O -9 C R A Vj0f
DIMENSION OF INSTILLATION OR R
!'Af nn -n1
SIZE
SIZE OF EXCAVATION, IF NEEDED
AL
APPROXIMATE TIME WHEN WORK WILL BEGIN
R6Lail,/2o �
1-
GtJ,�s 7—
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 saw the City, its authorized agems, 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 thepeit all applicable rules and regulations of the City of
rm
La Quints and to pay for any additional replacement necessary as the result of is rk_ --I
vi
Sign of Applicant or Agent g -p e , 5ry �� 2
Name of APO (please print) �� -) e
Bu ss Address Telephone No.
Name of Contractor and Job Foreman
Contractor's License No.
Business Address
Telephone No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subocvision 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.
$ l�
Received by . Date
Recorded by
PERMIT VALIDATION
PERMIT NO. / % 2
DATE APPROVED Z3
EXPIRATION DATE Z r-5
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246