1970NOTE:
Pith 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
DATE: 11/16/93
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
HAOI. BQDIPIII =
DESCRIPTION OF CONSTRUCTION 769 RiOIIX TRUCK
DIMENSION OF INSTALLATION OR REMOVAL 14"6"H, 12%
65%, 126,725 LBS
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class III
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:
ORIGIN: BAST CITY LIMITS
DESTINATION: KBLLRB PIT A 58TH
HAUL ROVrE: AIRPORT - MADISON —
58TH
EM DATE: 11/15/93
'-PILOT CAR REQUIM
I p
NOV 15 1993
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees; aymless f o d 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 permitgranted pursuant to this application.
1 .
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. /
Siggn/azure of Applicant or Agent
CATTRAC CONSTRUCTION, INC. 15030 SLOVEB X ., FONTANA, CA 92335 (909) 355-1146
Name of Applicant (please print) Business Address Telephone No.
SAME
Name of Contractor and Job Foreman Business Address Telephone No.
ON FM . ON FILE
Contractor's License No. City Business License No.
ON FM ON FM
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule 1970
Inspection Fee $ PERMIT VALIDATION
Permit Fee 0�10.00 1970
PERMIT N0.
Penalty DATE APPROVED 11/15/93
Cash Deposit -Surety Bond
if required EXPIRATION DATE 11/15/93
TOTAL: $ l 1/15/93
DATE1IS GE
Receipt No. 4
' 'BY
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
4 f
No
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Subdivision Improvement Permit -•• Class II I ,..,. _.....r...�.
DATE: --' Mlno Improvement Permit Class IV _..�,.
`LOCATION OF CONSTRUCTION
e IStrG1.t4ddrass or Description of Location?
.PURPOSE OF CONSTRUCTION Sketch (attachiconstruction plans if appropriate)
DESCRIPTION OF CONSTRUCTION'
DIMENSION OF INSTALLATION OR REMOVAL',
tZ 6?6rlft--r 61 7_25 4t -
7i PA TrV4
iiar►��sf�•�— •lt�' 6 tr --tz' la -- � s `�
AA"tv�
SIZE OF EXCAVATION; IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN:
APPROXIMATE TIME OF COMPLETION
ESTIMAtEO CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and planing permanent resurfacing and/or replacing improvements)
"In,,etMsidtratlor' of the giantirg of tflis'permit, the applicant lh:areby•..agrees_tc.:
Indemnify, defend and save the City, its euthorize4 agents, officers, representatives and employees, harmless from and against any and all
penalties, liablllties or Ipss resulting from claims or court action and arising out of any accident,,loss or damage to persons or property
'i hapgeninq or occurring as a proximate result of any work undertaken under the permit granted puisuant to this appitcation.
Noti;N the Administrative Authority at least twenty•four (24) hours in advance of the time when work will .be started.
Cor 01V with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
L.6 6ulnta and to pay for any additional reolacemgnt necessary as the result of this work.
A _ _ - .r
Signature of Appliqnt or Agent
-1146
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No,
Contractor's License No. City Busindss License No.
ApplfcanVs Insurance Company Poticy Number
FEES: Subdivision improvement Permit — Claes I II
Phlir irnnrovemente,- 104 „s ctlrrAtm,4 rnnetrm%tinr, rmett
I-- ,10,N.WruMV410. ,rrgN, aauntdleu v IMIukWoll wata N�
Minor Improvement Permit — Glass IV: See attached Schedule a
Inspection; Fee $
Permit Fel
Penalty.
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
i•d
PEhMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATF
DATE ISSUED
1 By
Administrative Authority
TELEPHONE: (61915134-2246
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