1774(
NOTE:
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 I II
DATE: 6/23/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION The Quarry
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Oversize Load Permit
DESCRIPTION OF CONSTRUCTION Cat 627B Scraper
12' Wide, 108' Len h. Height legal
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)
Sketch (attach construction plans if appropriate)
In consideration of the granting of this permit, the applicant hereby agrees to:
Route: Monroe St South to 58th
West to Keller Pit !d
Indemnify, defend and save the City, its authorized agerrts, 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 wills arted
Comply with all applicable City Ordinances, the terms and conditions of//the per it a_/all applicable rule�and regy#ations of the City of
La Quinta and to pay for any additional replacement necessary as the r4sult q this yvo'rk. 7 ]
Trism Specilaized Carriers
Name of Applicant (please print)
Name of Contractor and Job Foreman
PO Box .113
Si%gnature of Applicant or Agen-
0 �$(
Business Address /
Business Address
344-1912
Telephone No.
Telephone No.
Contractor's License No. City Business License No.
On Pile
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
Recorded by +
Date
PERMIT VALIDATION
PERMIT NO. 1774
DATE APPROVED 6/23/93
EXPIRATION DATE 6/24/93
DATE UE 6/23/93
�BY
Administrative Authority
r
TELEPHONE: (619) 564-2246
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.
DATE:—
LOCATION
ATE: LOCATION OF CONSTRUCTION
(Street hddress or Description of Location)
OF CONSTRUCTION
-SPo1f1-,+?'/ON
DESCRIPTION OF C NSTRUCTION CA -2-Z -27 -B
sC -Axi/f
Subdivision Improvement Permit - Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
�a9, 0e- s _r sot4h'-
DIMENSION OF INSTALLATION OR REMOVAL T G-16 G f} v
W IV riff /a-' LF.C-(TH iU'ee�f�r��n�
SIZE OF EXCAVATION, IF NEEDED
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 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 i and all applicable rules a lotions of the City of
La Quints and to pay for any additional replacement necessary as the rests of is rk.
Si ff. ure of Applicant or A l T CE5 7 yy/ T
Name of Applicant (please print) siness Address Telephone No.
Name of Contractor
Job Foreman
Business Address
Telephone No.
Contractor's License No. City Business License No.
0,4/ I lel,�
Applicant's Insurance Company Policy Number
FEES: Subolvision 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: $ l
Receipt No. /
Received by Date
Recorded by
1%30 8 6
PERMIT VALIDATION
PERMIT NO. - 17711"
DATE APPROVED
EXPIRATION DATE '2/2 -/
DATE ISSUED Z 3
By
Administrative Authority
TELEPHONE: (619) 564-2246