1993NOTE:
4
` Wi:uh proper validation
thyis form constitutes an
encroachment permit
CITY OF LA QUINTA
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
11/24/93 Subdivision Improvement Permit —Class I I I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVH EQUIPS Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 637 D SCRAPER,
14' 8"H, 13% 115,000 LBS
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
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:
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless fro -and against any and all t
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 result of this work.
HAUL ROUTE: WASHINGTON TO
52ND AVE TO MADISON STREET
HAIL% DATE: 11/26/93
PANT CAB RBQUn= s
FOV2fiN
4 1993
sr�A_r SIN
Signature of Applicant or Agent
CHANNRL & MARLOW LOWBBD
Name of Applicant (please print) Business Address Telephone No.
SAM
Name of Contractor and Job Foreman
ON FILE
Business Address Telephone.No.
ON FILE
Contractor's License No. City Business License No.
ON FILE ON FILE
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement. Permit — Class I II
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.
10:00
$ 10.00
Received by Date
Recorded by
19i3
PERMIT VALIDATION
PERMIT NO. 1993
DATE APPROVED 11/24/93
EXPIRATION DATE 11/26/93
DATE ISSOE0 14/24/93
By 4404Aaln
% Administrative Authority
E•.
TELEPHONE: (619) 564-2246
P 01
NOTF
With 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
Subdivision impruvement Permit — Class II I
DATE.
}- 3 &V f Minor Improvement Permit Class IV
-
LOCATION OF CONSTRUCTION�ir7—QEiNTA 129 Irld
`Street addrr.ss Ur Grutelptlon of LULihonl
PURPOSE OF CONSTRUCTION MOVE E(IPMM Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
HAUL ROUTE: ' TN- /�
-'HATS WA-S+�flr��h Yi 50 rto f/
7'o &7(x�ch SOn
HAUL DATE: 4~3 ! (• Q Co '`�
SIZE OF EXCAVATION, IF NEEDED PLOT E1UID
APPROXIMATE TIME WHEN WUHK WILL BEGIN
APPROXIMATE TIMI. OF COMPLETION
ESTIMATED CONST RUCTION COST S
(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 perrnit, the applicant hereby agrees to:
Indemnify, [defend and cave the City, ns authorized .lgpnts, offM•Prs, representatives and employees, hannit-%% from and against anv turd all
p@rl8hies, liabilities or lose resulting from claims or court action and arising out of any Fircident, loss or damage to persons or property
hupptming or occurring as a proximate remilt of any work undertaken under rip permit grunted pursuant to this applicEltion.
Notify the Administrative Authority 81 least twcnly-four (24) hours in advance of the time when wurk will be started.
Comply with all applicable City Ordinances, the terms and ronditions of the purnlit and all applicable rules and regulations of the City of
L,a Quinta :rod to pay for any additsunal replaccrnenr necessary v+ the rcoul,. of this work.
Signature of Applicant or Agent
CH&MEL & MAUOW LOWBED 84- E. D T AMA $'A f'7�4�4 92 eabbe
NamP of Applicant (please print) Business Address Telephone No.
Nance of Contractor and Job Foreman Business Address Telephone No.
ON FILE ON FT1,R
Contractor's UcRnsP. No. City Business License No.
4N FILE ON FILE
Applicant's Insurance CurtyJarly Policy Number
FEES: Subdivislon Improvement Permit — Class Ill
Public: Improvemerls: 3% of estimated conslructiun costs
o.i—to . v. eN„nmPntc• "P% nt PfitrmrtlRd COOS rLICtlOn Costs
Private improvements: 3% of estirnateif cunstruction costs
7
Minor Improvement Permit — C•.ass IV: See attached schedule
Wispcction Fpe $
Permit Fee 1 --
Penalty --
Gash Deposit-Suierty Burld
if required
TOTAL: $ IU
Receipt No.
Received by _ Date —
Recordcd by
Extended Page 1,1
YtGo`.l
PERMIT VALIDATION
PERwr NO. 1963
DA') E APPROVED / /
-Z�6, •-
EXPIRATION DATE �L �-�3
DATE ISSUED
By
Ad istrative Authority
TELEPHONE: (619) 564.2246
Post -It'" brand tax transmittal memo 7671 a of puges 1,
To
n 1 rror� ! N /gyp r�nC �•
cu — C�•
,& v,it. neL o�
Dept. ✓.. _ C I , i J., Dr,onon/U_.
%ice )7Inl IF"'17W-VI-
,