1786NOTE:
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
Subdivision Improvement Permit — Class III
DATE: 6/28/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION West end of Keller Pit Road
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
Load: 118K Dozer - 1416" wide,
126,725 lbs, all else legal.
Route: West end of Keller Pit Rd
over Keller Pit and 58th to
East City Limits.
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing a`nd/or replacing improvements) _
In consideration of the granting of this permit, the applicant hereby agrees to:
PILOT CAR REQUIRED
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 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 File
Contractor's License No.
On File
City Busine`s's 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: $
10.00
10.00
Receipt No.
Received by Date
76U
PERMIT VALIDATION
PERMIT NO. 6/29/93
DATE APPROVED 7/2/93
EXPIRATION DATE 6/28/93
DATE S UE
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
J�
Subdivision Improvement Permit — Class ill.
D fs 29 93 — 7/2/�� . Minor Improvement Permit Class IV .�
LOCATION OF CONSTRUCTION West End of Keller Pit Road, La uinta
(Street address or description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plant if appropriate)
Transportation Permit
Load: D -8'K Dozer
Dimensions: 14''6 wide, Legal heig
Legal length
Weight: 126r725 lb
Route: From west end of
Keller Pit•ower Keller Pit and
58th Ave to East City Limits
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S �� lib Gl4 1ZF-ZZt., P -E �
(Including removal of all obstruction, materials, and debris, backfilling, com.
Paction and placing permanent resurfacing and/or replacing improvements)
In consltieratlor, of the granting of this permit, the applicant hereby agrees tu:�
indemnify, defend and save the City, Its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or toss resulting from claims Or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a pra)timata result of any work undartaken 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.
-Name of .,Applicant (please print)
Signature of'AA-91icent or Agent
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 Ili
P"hlir imnrovementa! ?a r,¢ ActimAtorf nr+nctnrrrinn rmett
,'I,►.......,N, NVNI/1941UP .0ey MI ?;4UtlIll teu (;v116tlul;UU11 vtJStS s -�
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee S
Permit Fee
Penalty
Cash Deposit -Surety Bond
If required
TOTAL: $
Receipt No,
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE �' Q
DATE ISSUED
By
Administrative Authority
TELEPHONE., (619) 664.2246
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