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1893
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 9/24/93 Subdivision Improvement Permit — Class I II DATE: Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Ave 46 & Shields Road (Street address or Description of Location) PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Case 9150 14'High, 14'Wide, 60,000 lbs ROUTE: Jefferson, Ave 58, Madison, Ave 541, Jefferson up to Hay DIMENSION OF INSTALLATION OR REMOVAL 111. DATE: 9/27/93 SIZE OF EXCAVATION, IF NEEDED PILOT CAR REQUIRED 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) 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. Signature of Applicant or Agent Piconi Trucking 39723 Old Carriage Rd Murrieta 92362 (714) 677-8196 Name of Applicant (please print) Business Address Telephone No. Nuevo Eng ^, Name of Contractor and Job Foreman Business Address Telephone No. On File Contractor's License No. On File City Business License No. On File On File r - 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 $ 10.00 Date 'D PERMIT y i PERMIT NO. 1893'- DATE APPROVED 9/24/93 EXPIRATION DATE 9/27/93 LQ D SEP24 1993 D DATES UED 9/24/93 By Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 10.00 a\Sq\a3 WAN a\sv\aa T0600 18a3 ` 0Z bTr's ou BTTo Qvj I TTe OU UTS I;gc.�o BTCO'.T Lr.00lcTuC M33 OTq Cu"TURG Hq Nnxsie6Q ASM (]TO Q]]--BTaQ TVjfiTEP' ro,nTgv' @0'OD3 TPa c"e also ,-�3A8 DdaTbamur. 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