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1861i ,NOTE: 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 DATE: 8/31/93 Subdivision Improvement Permit — Class I II Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Westward Ho & Duna Palms Road R (Street address or Description of Location) PURPOSE OF CONSTRUCTION Move XQUIMPnt DESCRIPTION OF CONSTRUCTION Girder Le4W. highs wide 120 Zona, legal wAiaht DIMENSION OF INSTALLATION OR REMOVAL 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) Sketch (attach construction plans if appropriate) In consideration of the granting of this permit, the applicant hereby agrees to: ROUTSt Jeffersou South to Miles ,Ave, Wast to Dune Palms, South to Westward Ho OND TRIP ONLY PILOT CAR RE UIRBD Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all h 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. gni ture of YA'�ica to oar Agent US Brothers Transport .11333 Grasnstone Santa Pa Springs (800) 874-5512 Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business License No. On Filp. 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 10.00 ' $ 10.00 Date 1881 D�uDi AUG 31 1993 D PERMIT VALI'DAfitON' PERMIT NO. 1861 DATE APPROVED 8/31/93 EXPIRATION DATE 9/3/9$ DATE 5` UED 8/31/93 Administrative Authority TELEPHONE: (619) 564-2246 itIt 0 TRQ'SPC-IRTATION PERMIT ,A. M COMPLIANCE WITH YOUR REQUEST AND SUBJECT TO All OF THE TERMS, CONDI TIONS AND RESTRICTIONS WRITTEN BELOW AND THE ATTACHMENTS, PERMISSION IS HEREBY GRANTED TO. PERMIT VALID BETWEEN /� 3 AMi�v%PMr/ESS AND SUNSETMOVING AUTHORIZED NO SATURDAY ❑ ❑ SUNDAY SUNSET TO SUNRISE ❑ AUTHORIZED ' REPRESENTATIVE F103 3 �''%L� 5 e CITY/STATE `� � (5 �� SYES �� /V S Co PHONE 8? NCD. NO.' HAUL ❑ DRT4E ❑ TOW LOAD OR EQUIPMENT AND MODEL NO. TE{EODPIED PERMITS NOT VAUD WITHOUT SEAL. TYPE VEHICLE (�J KING PIN TO LAST AXLE COMB. VEHICLE LENGTH J SENDING TATI ©�� RECEIVING STATION LOADED DIMENSIONS DIFFERENT THAN ORR WEIGHTS EXCEEDING THOSE SHOWN BELOW ARE NOT AUTHORIZED HEI HEIGHT: MAX 4�5�AfllMAX WIDTH: OVERALL LENGTH: � /�% OVE �� l00 OVERHANCI:/V AXLE NUMBER 1 2 3 4 3 6 7 8 9 NUMBER TIRES AXLE SPACING AXLE WIDTH WEIGHT 0141 .� ORI I �L�� 1 DESTINATION TRIPS COUNTY AND/OR CITYPERMITSREQUIRED. Fe PLS 6 cs % L4 L L L, a e S Gv o PILOTCARJ YES NONE REQUIRED C ❑ ❑ Fl CASH E] CHARGE ZEE; 13 EXEMPT S I CERTIFY THAT ALL COUNTY AND/OR CITY TRANSPORTATION PERMITS HAVE f N OB ED // / G5 l AUTHORIZE AGENT SIGNATURE DATE IM DM-M-P-16(ilm l-89) ORIG-Permi/fee 89 86483