1972NOTE. ,
�'• With P ervalidation
,
II" !
th� form constitutes an 1
encroachment permit CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS `CONSTRUCTION (ENCROACHMENT)
I
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: 11/15/93
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE
Subdivision Improvement Permit — Class 111
Minor Improvement Permit Class IV
DESCRIPTION OF CONSTRUCTION D6 DOZER
10% 11'10"W, 40,000 LBS
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
HAUL ROUTE: SOUTH ON JEFFERSON
FROM CITY LS TO AVE 54
EAST ON AVE 54 TO MADISON
SOUTH ON MADISON TO AVE 58
RBST ON -AVE 58 TO THE QUARRY
HAUL DATE
APPROXIMATE TIME WHEN WORK WILL BEGIN D
APPROXIMATE TIME OF COMPLETION + NOV 15 1993
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)( By
In consideration of the granting of this permit, the applicant hereby agrees to:
t
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees; harmless from and against an;nd all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or pperty
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 tirre•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 res It of this wor
f
Signature 6f Applicant or Agent
PICONI TRUCKING 39723 OLD C•RRUM RDS, NVRRIETA,'CA1 92362 (714) 677-8196
Name of Applicant (please print) Business Address Telephone No.
NUEVO EN6IIfBEgINGa INC. 79-811 COUNTRT CLUB
I
DUNES
345-1778
Name of Contractor and Job Foreman Business Address i Telephone No.
ON PILE ON FM
Contractor's License No. City Business License No.
ON FILE ON FILE'
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
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
i
1972
PERMIT VALIDATION
PERMIT NO. 1972
DATE APPROVED 11/15/93
r
EXPIRATION DATE 11/15/93
DATE IS UE + 11/15/93
By
Administrative Authority
TELEPHONE: (619) 564-2246
i�
A
y
N ria ,ti, — 1 'D - _•
�Q
Vitotoper validation
ttls form oonstitutet an
encroadiment permit
r-1 f -r N ':;1 . 0 N U E '•:' 0
t
i
k U. Y O(F
APPLICATION
EEER I NG
LA 4UINTA
FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
":3 tI
for the can%truction of public or private curbs, drivt� ays, Favernenls, sidewalks, parking lots, sewers, wAler mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVE() SUBDIVISiONS
L •? Subdivision improvement Permit - Class III
OATS: 11-15-93 s. Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Located "ate-► '
(Street address or nescriptlon of t_otstionl
PURPOSE OF CONSTRUCTION MOVE SRU PMENT
DSO rl N Pf0g0W STpuCTION D6- DOZER t
-- 404 00 L997
,
DIMENSION OF 114STALLATIbN OR REMOVAL,
SIZE OF EXCAVATION, IF NEEDED
,APPROXIMATE 11ME WHEN WORK WILL BEGIN --- - --
APPROXIMATE TIMI: OF COMPLETION
ESTIMATED CONI TRVCT10N COST S
Iinciuding removal, of all obstruction, materioit, and deb. It, backfilling, con
paction and placing permanent resurfacing and!or replacing Improvements
Sketch (attach construction plans if appropriate)
HAUL ROUTE: South on Jefferson
from city Ia.mits to Ave 54
East on Ave 54 to Madison
1outh on Madison to Ave 58
est on Ave 58 to the Quarry
//,,V" I)�iQ : 1111j1—r:3
in consideration of the granting of this permit, the applicant hereby agrees to
Indemnify, defend end save the City, its authorized agents, officers, teprssent tival and emptoyi
penalties, liabilities or lots resulting from claims or court action and arising out, of my accidei
•happening, of .Occurring as ! proximate result of any work undertaken under the permit granted
Notify the Adrininistrativa Authority at least twenty-four 1241 hours in advance of the tirM who
Compiy with all appticabte City Ordinances, the terms and condittons of the permit end all spot
La Oulom and to pay for any additional replacement neuuary as tha,f� of this work.
A-a i -r lk-' ..
of Applicant or
. 'c`ir1l ci7J.P R_ �` Mrr
Name of Applicant (please printf Business Address
Name of Contractor and Job Forern�n _
9usiness Address
Contractor's License No. -
s, hermiest from and agetnrt any and all
, loss or damage to persons or property
Wrsuent to this eppliCstlon•
work will be flartM.
able rules and regulations of the City of
gent
7-1 LLI TZ -81 6
Telephone No.
�i7.8
._r+F Telephone No.
+yy'01531ness license No.
Applicant's Insurance Company - "—
Policy Number
EES: Subdivision Imarovement Permit - Class III
4�---
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit -- Class IV: See attached schedule
nspection Fee
Iermit Fee
'snotty
:ash O .'_'"' .^....a....
'posit -Surety Bond
'required ,
TO rAl: ����
$
lecelpt No,
leceived by Date,...
-leCorded by
.PERMIT VALIDATION
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPM NE: (619) 664-2246.
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