1901NOTE:
With proper validation X04 Q
this form constitutes an CITY OF LA QUINTA
encroachment permit s
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
September 28, 1993
LOCATION OF CONSTRUCTION La Fonda
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION eve Equipma
DESCRIPTION OF CONSTRUCTION Crane — 14'6' H,
1016' W. All Else Lesal
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
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:
ROUTBt WASHINGTON - TAMPICO
LN VONDA
9/29/93
Lr �1
D
SEP 2 9 1993
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
j
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 a all appl' abler es and regulation "f the City of
La Quinta and to pay for any additional replacement necessary as the result of th' rk. 00
/,t—
Signav�re"Qflrpplicant k Age l./
Dalton Trucking 1$360 Whittrals Ave., Fontana, CA 92335 (714) 823-0663
Name of Applicant (please print)
SAME
Name of Contractor and Job Foreman
On File
Contractor's License No.
Business Address
Telephone No.
Business Address Telephone No.
City Business License No.
On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class Ill
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
1901,
PERMIT VALIDATION
PERMIT NO. 1901
DATE APPROVED 99/j28/9j3
EXPIRATION DATE 9!09193
DATE ISSU D �'_ a g - `
By
U Administrative Authority
TELEPHONE: (619) 564-2246
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