1829Ali
N
ROTE:_ '
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 I I I
DATE: 8/5/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Del Webb
(Street address or Description of Location)
d
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 623 Scraper'
14' High, 10' Wide, 80,000 lbs ROUTE: Ave 58, Madison, Ave 54,
Jefferson, Country Club
DIMENSION OF INSTALLATION OR REMOVAL
DATE: 8/6/93
SIZE OF EXCAVATION, IF NEEDED 'r
r
APPROXIMATE TIME WHEN WORK WILL BEGIN t
e
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.
--,,,—.f
` Signature of Applicant or Ag
�
Ficoni Trucking
Name of Applicant (please print) Business Address Telephone No.
Nuevo Engineering Inc
Name of Contractor and Job Foreman Business Address Telephone No.
On File On File
Contractor's License No. 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 i
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
4
PERMIT VALIDATION
PERMIT NO. 1829
DATE APPROVED 8/5/93
EXPIRATION DATE 8/6/93
DATE ISSUED (, 8/5/93
By
�—T—Administrative Authority
TELEPHONE: (619) 564-2246
y
I
4
-NMF
:d
With proper validation
th1 folm Constitutes an
enccoachmerit permit
CiTY OF LA OUINTA
APPLICATION FOR PERMIT
PUBLIC WOnKS CONSTRUCTION (ENCROACHMENT)
roe the wnstrUction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers..wa
and other like public works frnprovements in connect -on with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit - Class 111
DATE: _ _ i� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Del Webb
iStreet cddrtas or Description of location)
PURPOSE OF CONSTRUCTION Move Equipment
DESCRIPTION pF CONItgUVIO523 Scraper
—
4 High, lu W , 0,000 ItTs.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGtM
APPROXIMATE TIME OF COMPLETION
ES1 IMA T ED CONSTRUCTION COST 2 �w
i, nuud,ng removal of ale obstruction, materials, and deb; is, backfilling, com-
aectrun anti irking permanent resurfacing and/or replacing improvements)
in cvnsrderction of the granting of this permit, the applicant hereby agrees to:
Sketch (attach construction plans if approprlate)
Ave. 58, Madison, Ave. 54,
Jefferson, Country Club.
Haul Date: 8/6/93
lodrImn,iy, derand and cava the City, its authoilred agents, officers, representatives and employett, harmless from and against any end all
pt^0'Go¢. Idchfllr:es or lot¢ resulting from claims or court action and ariting out of any accident, lost or damage to persons or property
h,pp.mng or Occurring as a proximal* result of any work undertaken under the Permit grtnted pursuant to this application.
Nobly rho Acknul,irrative Authority at 19819 twomtydout 1241 hours in advanco of the time when work will be started.
Cc:mt),y w th all appr+cabta City ordinances, the terms and condition¢ of the permit and all eppgcabte rules and r"ufttions of the City of
Lc Quintc a,,d to Vey for any additional replecertKnt necti ary as the result of this work.
Signature of Applicant or Agent
Name of Applicant Wease print) No, 71�i 1, 6
Business Address Telephone No.
Name of Contractor and Job Foreman 7y- 11 ('�!r-n..jLv C'i lin irC.. prrni�a�usiilf'' SII ci-1 ,
7?
Business Address �'—•
Telephone No.
_____ 'Ll—Ir L-10 _
Contractor's License No _
Oft 119
City Business License Na. -----�r.'
Applicant's Insurance Company Policy Numher
F2ES: Subdivision Improvement Permit Cfass I11
Public Improveinents: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit -- Class IV: See attached schedule
r4tkction Fee $
'omit Fee
`
anality
.ash Deposit -Surety Bond
` required
TOTAL:
lecelpt No.
lecelved Ly Date
ecordyd by y_
N�
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED _g' S 'C 3
EXPIRATION DATE g�l� f" 3
• DATE ISSUE¢ a—s-oL3
ev
Administrative Authority
TELEPHONE: 16191564-2246