1924NOTE:
W�h proper validation
this form constitutes an CITY OF LA QUINTA D a
encroachment permit
APPLICATION FOR PERMIT OCT.
PUBLIC WORKS CONSTRUCTION (ENCR ACHMENJ:)
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: 10/13/93
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION KIM BQT Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION CAT 637 SCRAPER
DIMENSION OF INSTALLATION OR REMOVAL 15' H, 13' W,
175,000 LBS, 80' L ALL ELSE LEGAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 10/13/93
APPROXIMATE TIME OF COMPLETION 10/13/93
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:
HAUL ROUTE: WASHINGTON 52ND AVE —
JEFF1l3RSOx - 54TH AVE xADlsox —
�58TH AVE — KRUA R PIT ROAD AND
RETURN
HAUL DATE: 10/13/93
PILOT CAR REQUIRED
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 orpropertyi•
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. `�"f•a,�
Signature of Applicant or Agent i
DALTON TRUCICWG, INC. 13560 WHITTRAM, PONTANA, CA 800/333-2400
Name of Applicant (please print) Business Address Telephone No.
SAtiE
Name of Contractor and Job Foreman Business Address Telephone No.
Ox ME ON FILE
Contractor's License No. �. City Business License No.
ON YM ON FILE
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 1924.
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by
Recorded by
Date
PERMIT. VALIDATION
PERMIT NO. 1924
DATE APPROVED 10/13/93
EXPIRATION DATE 10/13/93 p
DATE ISSUED 0'
By
Administrative
TELEPHONE: (619) 564-2246
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