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1888} —0 ti 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 II I DATE: 9-21-93 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 52 & Bermudas (Street address or Description of Location) PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION PC Excavator Haul Route: North City limits on Washington to Ave 52 west to Bermudas DIMENSION OF INSTALLATION OR REMOVAL 1171 1010% 104"w 248,0001bs SIZE OF EXCAVATION, IF NEEDED I-- one trip only APPROXIMATE TIME WHEN WORK WILL BEGIN I Payor CAR ; 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: Qa SEP -2 1 1993 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 i24) 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. *�nature`of Applicant or Agent Denko 1694 91st Ave Blaine MN. 55449 1-800-344-1912 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 file on file Applicant's Insurance Company Policy Number r 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. 10 $ 10 Received by Date 1888 PERMIT VALIDATION PERMIT NO. 1888 DATE APPROVED EXPIRATION DATE 9-21-93 9-24-93 DATE ISSUED 9-21 By A ministrative Authority i Recorded by 11 TELEPHONE: (619) 564-2246 0 NOTE: With proper validation this form constitutes an encroachment permit CIN OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For the construction of public or private curbs, driveways, pavemerra, sidewalks, parking lou, sewers, water mains and other like public works improvements in connection.with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS DATE: 9 l Cl 3 LOCATION OF CONSTRUCTION (Street address or Oesenption of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONST DIMEN41PN OF INSTALLATIONqR REMOVALS e,, arc I 4t' Sl * Uj,f U P Subdivision Improvement Permit — Class 111 Minor Improvement Permit Class IV Sketch (attach construction plans if appropriate) z1_-�`'��� r 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. Pwtion and placing permanent resurfacing and/or replacing improvements) 5 �- � ,�����&_7 In consideration of the granting of this permit, the applicant hereby agrees to: Ind ammfydefend and save the City, its authorised agafRs, office,.Iting from claims of court action and arising Out reoresentatim and efnployep, harmless from and pairst any and all Penliabilities iabilltlq Of 100 resYO} any accident, lose or happening Of OCQrRing tl a pf0timaq result Of a damage to peflone or, property any woft undertaken under the permit granted pursuant to this application. Notify the Administrstrw Authority at least twenty-four 1241 hour 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 Quints and to pay for any eddltlontl replaamemt necasssry as the result Of this work, Name of Applicant (please print) signature of Applicant or Agent 1 & q y 9 / .4ue 91A,= Business Address Zip 5°w 1-1 ; n 1*70 Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business License No. 4AI Applicants Insurance Company Policy Number FEES:, Subaivision 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 Date Recorded by PERMIT VALIDATION PERMIT NO. DATE APPROVED t EXPIRATION DATE - 9 3 DATE ISSUED By Administrative Authority TELEPHONE: (619) 564.2246 4