1881NOTE:
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 III
DATE: 9"16-93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION PC 220 excavator Saul Route:
South on Washington St. West on 52
to Bermuda[`s And Hidalgo
DIMaENSIOT OF INSgTaALLATION OR REMOVAL 1 wide t
SIZE OF EXCAVATION, IF NEEDED O
APPROXIMATE TIME WHEN WORK WILL BEGINSEP 1 6 1993
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 K11tof
perm and)l I applicable rules and egulations of the City of
La Quinta and to pay for any additional replacement necessary as the res; is wo
Keriko
Name of Applicant (please print)
Name of Contractor and Job Foreman
Contractor's License No.
1694 91st Ave
`ig ture of Applicant or
y e Iii 55449
siness Address
Business Address
e
(612) 786-6510
Telephone No.
Telephone No.
City Business License No.
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 Imorovement Permit — Class IV: See attached schedule
Inspection Fee $ 10
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10
Receipt No.
Received by
Date
PERMIT NO.
PERMIT VALIDATION
1881
DATE APPROVED 9-16-93
EXPIRATION DATE 917-93
DAT S p 9-16-93
By�
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
Exnlol c H
:n ZJMr+L IAP7CE WITH TOUT ^rte 3Z"vi' w ^« w' :. : '—. wrvu:•
TIONS AND RESTRICTIONS WRITTEN BELOW AND THE ATTACHMENTS. PERMISSION IS
HEREB: GRANTED TO:
PERMIT VALID BETWEEN
AM
PM
AND SUNSET
�(��
y
I AUTHORIZED AGENCY REPRESENTATIVE
,;'SPORTER
ADD RE
v�
MOVING AUTHORIZED
YES NO
SATURDAY 11 13j
SUNDAY El 11l/
SUNSET TO SUNRISE ❑ ❑
CITY/STATE
d %:/
��
PHONE "
.-
MCD.
NO.
HAUL
❑ oarvE
❑ TOW
LOAD OR EQUIPMENT AND MODEL NO.
TELECOPIEO PERMITS NOT VALID WITHOUT SEAL
'2 2 O
TYPE VEHICLE
3A � � <�L
KING PIN TO
LAST AXLE 0
COMB. VEHICLE`
IENGTH
/
I SENDING STATION
RECEIVING STATION i
LOADED DIMENSIONS DIFFERENT THAN OR WEIGHTS EXCEEDING THOSE SHOWN BELOW ARE NOT AUTHORIZED
HEIGHT: ✓
IW DTH:y� I
�/,
OVERALL LENGTH:
OVERHANG: A
•(
AXLE NUMBER
1
2
3
x
S
6
7
B
q '
NUMBER TIRES
i
I
AXLE SPACING
AXLE WIDTH
WEIGHT
I / - /� A
ORIGIN
rY G iv?' /—r ' rvi�
DESTINATION
c F : 1441'a
,[JI n�
TRIPS i
/ .
AUTHORIZED ROADSISTREETS/HIGHWA S it OTHER AGENCY PERMITS REQUIRED
V P
5a 0�w
VT'
CIO
PILOT CAR ❑ YES ❑ NONE REOUIRED
ATTACHMENTS
❑ PERMIT CONDITIONS
,
❑ CASH
❑ CHARGE FEE:
❑ EXEMPT S __
C l�
/ /J
ERMITTEES AU7 RIZED A (S*NATURE) DATE
i
a