1858NOTE: -
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: 8/25/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Westward Ho 4 Dun* Palmy Road
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Motle RQU11Ment
DESCRIPTION OF CONSTRUCTION Steel Gik'3ei
120 overall length, legal H, leItal w',
1 wti.
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
ROUTEt NO.CITT LIMITS WASHINGTON
ST, S0, TO MILES, EAST TO
DUNE PALMS SO. T! WESTWARD
HO
SIZE OF EXCAVATION, IF NEEDED DATEt 8/30/93
APPROXIMATE TIME WHEN WORK WILL BEGIN PILOT C" REQUIRED
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ O
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) AUG 2 5 19!
In consideration of the granting of this permit, the applicant hereby agrees to: R��
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless rbfd –
__
--
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to pers 11-0j—pro
happening or occurring as a proximate result of any wor< 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
US Brothers Transportation 11333.0reenatona Ave Santa !e Sgrings (310) 903-1070
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
Contractor's License No.
Business Address
Telephone No.
City Business License No.
The Travlera Indeamity 650-385J4683
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I 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
$ 10.00
Date
1 858
PERMIT VALIDATION
PERMIT NO. 1858
DATE APPROVED
8/25/93
EXPIRATION DATE 8/30/93
DATE�SSIUED 8/25/93
t
�y E
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
&i9
-7-77 -7101
TRANSPORTATION Pq 21
IN COMPLIANCE WITH YOUR REQUEST AND SUBJECT TO All OF THE TERMS, CONDI a PERMIT VALID BETWEEN
TIONS AND RESTRICTIONS WRITTEN BELOW AND THE ATTACHMENTS, PERMISSION
IMBY GRANTED TO, n_
NAME RD T A„r,
�5 3RD �f�PM
ADDRESS
AND SUNSET
) ✓ o
,oj/0
, MOVING AUTHORIZED
CITY/STATE No �
L O
0 � SATURDAY e'
W Y v,
PHONE CD . SUNDAY 0
90�� �5E7 TO SUNNIS? ❑
- o O
AUTHORIZED '
REPRESENTATIVE
M"H UL
LOAD OR EWIPMENT AND MODEL NO.
TELECOPIED KRMI.M NOT
VAUD WITHOUT SEAL
DRIVE
❑ TOW
TYPE VEHICLEy� n
v / l 4 l
LAST AXLEKING PIN TO
LENGTH VEHICLE ��
aJ�
RECEIVING
O 7C,
LOADED DIMENSIONS DIFFERENT THAN OR WEIGHTS EXCEEDING THOSE SHOWN BELOW ARE NOT AUTHORIZED
MAX
HEIGHT: /�
MAX I
WIDTH:
MAX
OVERALL LENGTH: O '
MAX
OVERHANa2/�/ /)
/
AXLE NUMBER
1
2
3
4
S
6
7
8
9
NUMBER TIRES
AXLE SPACING
AXLE WIDTH
WEIGHT
ORIGIN
�5 "�
DESTINATION
Ive-bnVorL-� mve aims
TRIPS
T
CFUNTY AND/OR CITY PERMITS REQUIRED.
7-0 Gr/69'lL D
PILOT CAR YES ❑ NONE REQUIRED
C
El
13
El❑
❑ CASH I CERTIFY THAT A t COU ND/OR CITY TRANSPORTATION .PERMITS
HAVE BEEN D 7T742 g;-
_ CHARGE FEE,
1:3❑
13EXEMPTS
El
AUTHORIZED AGENT SIGNATURE DATE
DM -M -P- 16 (Rev. 1-89) ORIG—Permittee
99 06493
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