1789NTE•)
With proper validation ,r
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: 6/29/93
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION West end of Keller Pit Road
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
Load:
DIMENSION OF INSTALLATION OR REMOVAL Route:
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
988B Loader - 16'4" high,
12' wide, 85' long, 192,000
lbs.
West end of Keller Pit Rd
over Keller Pit Rd & 58th
to the East City Limits &
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 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 15030 Slover Fontana (909) 355-1145
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 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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
789
PERMIT VALIDATION
PERMIT NO. 1789
DATE APPROVED 6/29/93
EXPIRATION DATE 7/2/93
DATE I SED 0/29/93
Byt7 I
Administrative Authority
TELEPHONE: (619) 564-2246
Subdivision Improvement Permit — Class I II.
DATE29 9,3 — 7/2/93 Minor Improvement Permit Class IV
-LOC4TION OF CONSTRUCTION
West Enol, of Keller Pit Road, La Quinta
- --
($treat addrou or Doscriptl'on of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALL .TION OR REMOVAL
Sketch (attach construction pians if appropriate)
Transportation Permit
Load: 988E loader
Dimensions: 161.411 high, 121011
wide, 8.510° long.
Weight:192,000lb
SIZE OF EXCAVATION, IF NEEDED Route: From the west end of
Keller Pit Rd over Keller Pit
and 58th Ave to the East City
APPROXIMATE TIME WHEN WORK WILL BEGIN 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 improvements)
in consideratior of the granting of this permit, the applicant hereby agreas tc•:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless. f ram and against any and all
penalties, liabillt€as or lost resulting from claims or court action and arising out of any accident, loss or damage to parsons or property
happening or occurring ns a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twemy•four (24) hours in advance of the time when work will be started.
Comply with ell applicable City Ordinances, the terms end conditions of the permit and all applicable rules and regulations of the City of
La Quints and to pay for any additionel replacement neeassary as the result of thi work.
s %
Name of Applicant (please print)
Signature of Apant or Agent
-1146
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 Numbar
FEES: Subdivision Improvement Permit —Class III
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Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Data
I Recorded by
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PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION BATE 7 Z Q3
DATE ISSUED
By
Administrative Authority
TELEPHONE- (818) 564.2240
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