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1794i {�-• ..fes �: -. NOTE: 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: 7/1/93 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION The Quarry (Street address or Description of Location) PURPOSE OF CONSTRUCTION Move Equipment DESCRIPTION OF CONSTRUCTION (2) 637 Scraper 154" High, 13' Wide, 75' Long, 160,000 lbs DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED Sketch (attach construction plans if appropriate) Route: Jefferson So off Hwy 111 to 54th East to Madison South 58th to Keller Pit Road Date: 7/2/93 PILOT CAR REQUIRED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION P A I , 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. Signatu,P :f1 p icant or Agent 1-1 Dalton Trucking 13560 Whittron Fontana (909) 823-0663 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 $ , 20.00 It, $ 20.00 4 Date. 9� PERMIT VALIDATION PERMIT NO. 1794 DATE APPROVED 7/1/93 EXPIRATION DATE 7/2/93 DATE -ISSUED .- n7//1/93 By f� Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 �k N NOTE: 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 DATE: Subdivision Improvement Permit — Class III LOCATION OF CONSTRUCTION Minor Improvement Permit Class IV . (Street address or Description of Location) PURPOSE OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST S (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 saw the City, its authorized agems, 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 propeity 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 1241 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 applicableides a regulations of the City of La Quints and to pay for any additional replacarnent necessary as the result of this work. // Sketch (attach construction plans if appropriate) )��Q)akttv� Name of Applicant (please print) Signature Business Address wff(wn Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. f'v,� (), I - City Business Liipense No. Applicant's Insurance Company %.�It I % x�-- Policy Number FEES: Suboivision Improvement Permit — Class II I 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 Date Recorded by PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By TELEPHONE: (619) 564.2246 VFj Administrative Authority