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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
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FEES: Subdivision Improvement Permit — Class III
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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,
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IN?
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
. DATE ISSUED „
13y,.
Administrative Authority
TELEPHONE: (619) 584-2246
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