1895With 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
DATE: 9/24/93
LOCATION OF CONSTRUCTION Ave 46 & Shields Road
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment
DESCRIPTION OF CONSTRUCTION 623 Scraper
16 High, 10'Wide, 80,000 lbs
DIMENSION OF INSTALLATION OR REMOVAL
Subdivision Improvement Permit — Class, Ill
Minor Improvement Permit Class I'VE
Sketch (attach construction plans if appropriate)
ROUTE: Jefferson, Ave 58, Madison,
Ave 54, Jefferson up to Hwy
111.
RETURN: Jefferson, Ave 50, Washington,
SIZE OF EXCAVATION, IF NEEDED Ave 48.
APPROXIMATE TIME WHEN WORK WILL BEGIN
DATE: 9/27/93
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.
4 &�,adz if
Signature of Applicant or Agent
Piconi Trucking
Name of Applicant (please print) Business Address Telephone No.
Nuevo Engineering
Name of Contractor and Job Foreman Business Address Telephone No.
On File On File
Contractor's License No. City Business License No.
On File On file :,rt
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
20.00
$ 20.00
Received by Date
D
1 895
SEP 2 93
PERMIT A BWATIO
t i __
PERMIT NO.1895.
DATE APPROVED 9/24/93
EXPIRATION DATE 9/27/93
DATE UF,�D 9/24/93
By `�\
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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