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1785NOTE:." With proper Val dation this form'co;nstitutes 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 DATE 6/29/93 Subdivision Improvement Permit — Class I II Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION West and of Keller Pit Road (Street address or Description of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Load: 631 Waterpull - 14'10" high, r 13' wide, 85' long, 185,000 lbs. DIMENSION OF INSTALLATION OR REMOVAL Rout: West end of Keller Pit Rd over Keller Pit Rd & 58th to East City Limits & return SIZE OF EXCAVATION, IF NEEDED unladen. APPROXIMATE TIME WHEN WORK WILL BEGIN PILOT CAR REQUIRED 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 Applicant or Agent Cattrac Construction Inc R8XW 15030 Slover Fontana (909) 355-1146 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. On Fibe Contractor's License No. On File On File City Business License No. 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 Recorded by 10.00 $ 10.00 Date PERMIT NO. 1785 PERMIT VALIDATION 1785 DATE APPROVED 6/29/93 EXPIRATION DATE 7/2/9 DATE IS UE /29/93 By Administrative Authority TELEPHONE: (619) 564-2246 DATE: 6 29/93 7/2/y3 Subdivision Improvement Permit Class Ili Minor Improvement Permit Class IV - LO,;�4TION OF CONSTRUCT!ON West End of Xeller Pit Road, La Uinta (Street address or ONcription of Locatlonl PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Transportation Permit DIMENSION OF INSTALLATION OR REMOVAI..,,...o, SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Load: 631 Waterpuil ' Dimensions: 14'10" high, 1310" wider 85"0" long Weight: 1851000# gross Route: From Webtr.end,-,, of Keller Pj over Keller Pht and 58th live to East City Limits and return unladen. 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 iml'rovements) In consideration of the granting of this permit, the applicant hereby agrees tc,: Indemnify, defend and save the City, its authorised agents, officers, representetives and employees, harmless from and against any and all penaltles, liabilities or loss resulting from ciaims or court action and arising out of any accident, Ipso or damage to parsons or property happening or occurring as a proximate result of any work vndertaken under the perms granted pursuant to thio application. Notify the Adminimrativa Authority at least twenty-four (241 hours in advance of the time when work will be %tamed, Comply with ail aRplicable City Ordinances, the terms and Conditions of the permit and ail applicable rules and ragulations of the City of La Culnta and to pay for any additional replacement necessary as the result of this work, Signature pplicant or Agent actio I o 15030 r er AV ontan Ca 4231 r9 Name of Applicant (please print) Business Address Telephone No. 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 P1lhiir imnrovament- 194 of ^ctim.xtoA r.rn5trl;rflnn mall" "A - — w 1-1-Wl OVEiIla ,Iit) . . 14 ,1 0:411#WhUld t.U"IAt""1CtIlulI Wp1ty �^ Minor Improvement Permit — Class IV. See attached schedule e Inspection Fee $ Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by - • Date Recorded by -:_aa;sr+auw,�•,�yaunem-�ua�ccj_ ,.::_r___.suaw, z'd PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DAVE Z Q 3 DATE ISSUED By Administrative Authority TELEPHONE: (619) 564.2246 ,oHi NOIionNismoo Dtizilldo g©:60 66. 6Z wnf M. m I s