1927NOTE:
1Nithlproper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
' 7 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: 10/13/93
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION KM B4UIPllIW
DESCRIPTION OF CONSTRUCTION 735 8/T CRANE
DIMENSION OF INSTALLATION OR REMOVAL 1416" H,
11' W, 651 L
SIZE OF EXCAVATION, IF NEEDED
;. APPROXIMATE TIME WHEN WORK WILL BEGIN 10/14/93
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 10/14/93
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:
HADL ROM: LA FONDA TO NORTH
CITY LIMTS ON WASHINGTON
HAL DAli 10/14/93
i
Qa
OCT 14 1993
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
4
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 resultoft is work.
AI 00,41(
Signature of Applicant or Agent
DALTON TRUCKING, INC. 13560 WHITTRAM AVE., FONTANA, CA 92335 (714) 823-0663
Name of Applicant (please print) Business Address Telephone No.
SAM
Name of Contractor and Job Foreman Business'Address Telephone No.
ON FII.B
Contractor's License No.
ON FM
City Business License No.
ON P= ON FM
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
Recorded by
10.00
$ 10.00
Date
927.
PERMIT VALIDATION
PERMIT NO. 1927
DATE APPROVED 10/13/93
EXPIRATION DATE 10/14/93
DATE ISSUED
By \
Administrative Authority
TELEPHONE: (619) 564-2246
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