1782NOTE:
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: 6/28/93
LOCATION OF CONSTRUCTION The Quarry
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Wguipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION D8K DO7,er,
14' High, 13'6" Wide, 99'10" Long, 190,000lbs Route: Jefferson South off Hwy ill
to 54th East to Madison So.
DIMENSION OF INSTALLATION OR REMOVAL 58th Keller Pit Road
Date: 6/28/93
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 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 this work'
Signature of Ap1plicant or Agent
Dalton Trucking 13560 Whittsam Fontana (909) 823-0663
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
On File
Contractor's License No.
Business Address Telephone No.
On File
City Business License No.
On File On File
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
10.00
$ 10.00
Date
PERMIT NO
PERMIT VALIDATION
1782
DATE APPROVED 6/28/93
EXPIRATION DATE 6/28/93
DATE ISSUED 6/28/93 /�
By 'Tt4/� Y
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246