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1790t .. N�E•c-' w 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 111 DATE: 6/29/93 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 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: (3) 1119 Dozers - 106" high, 12' wide, 85' long, 185,000 lbs. West end of Keller Bit Rd over Keller Pit Rd & 58th to east City Limits & return unladen. 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 A n Cattrac Constructinn Tne 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 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 Recorded by 30.00 $ 30.00 Date PERMIT NO 1.790 PERMIT VALIDATION 1790 DATE APPROVED 6/29/93 EXPIRATION DATE 7/2/93 r DATEISS•ED 6/129/93 , By AJA dministrative Authority TELEPHONE: (61`9) 564-2246 X411t - C. "*� �.� Subdivision Improvement Permit —Class Ill �,,._ �q: 6 29/93 — 7/2/93 Mlnor Improvement Permit Class IV .,,�_ LOCA 10N OF CON$TRUCTiON W®at Ertd of K®11fax ?fit Ptoad La Uinta IStreet address or Description of Lcimlon) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL.. -- SIZE OF EXCAVATION, IF NEEDED Sketch (attach construction plans if appropriate) Transportat Tori Perinit Load: 3 D-'9'Dozers Dimensions: 1416 high, 85' long Weight: 185,000 The Route; From the west end Keller Pat Rd over Keller APPROXIMATE TIME WHEN WORK WILL BEGIN and 58th Ave to hast City and return unladen 12' wide of Pit limits. APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris, backfilling, comr Paction and planing permanent resurfacing and/or replacing improvements) e—.. .—•_,.�.. � ____ In consideratior 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 tweniv,four 1241 hours in advance of the time when work will be started, Comply with all applicable City Ordinances, the terms and conditions of the perrnit and ail aPollcable rine and regulations of the City of l.e Ouintp and to pay for any additional•replacement necessary as the result of tis work. . Name of Applicant (please print) Signature scant or Agent 1,.9.6 Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. dont actor's License No, Cfty Business License No. Applicant's Insurance Company Policy Number 4Ylt4nc3-_': .... �.,+Vr1f1—'9�gWi311�^" �.�rL�f'RBq/IIL6�Y�tlGmY�L•••..�•-_��Z,��—.. .3i�,W�r.��.��.���. FEES: Subdivision Improvement Permit — Class III P-,hlir imnrovementy vat. ^6-ttirmAti-I r:nnstrilrtinn rnett „•.,•� .,:,Mlwu ilnlua. .+,u U. aourudtnu QVllb1f VflUu wawa Minor improvement Permit — Class IV: See attarrhed schedule Inspection Fee Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. 30 $ 30 Received by ..�.�, _ _ Data Recorded by ,..�a, emr•—'---"".r.—„ ��....�...._._.,.........-r-•--i-rrn,an1 -�n�r�•ucau�m�nnl.r,.� IN? PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE . DATE ISSUED „ 13y,. Administrative Authority TELEPHONE: (619) 584-2246 b'd 'oNI 'NUIlof Niswoo odi_Iliuo 10:60 E6, 62 Nflt -V . i