2043NOTE:
With proper validation
this 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
Subdivision Improvement Permit — Class I II
DATE: 1124194 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Rancho La Quinta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment
DESCRIPTION OF CONSTRUCTION
623 Scraper 14'H 12'W 80,000
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED It -
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:
Sketch (attach construction plans if appropriate)
Haul Route
Washington St To Ave 48th
and Washington ,
Haul Date 1/ 2 / 4 _ 14N2 lg9
ey 4
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 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.
,
V1_1 nn,�,t Q 0 1/
Signature of Applicant or Agent
1 III -01\1I tKtoC,K11\IF_ Ll -14 1) C2LU IL— IML K1KiG MU ( ]I`11 b71—XI`/IQ
Name of Applicant (please print) Business Address Telephone No.
bit Vo -la 11,1 eeI, I�-,o 11 c -4c1- gt 1 ('Q1)ALl moi« b
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business Li ense N
vn �I� Ot -PI Ie_
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
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: $ 1 —
Receipt No.
Received by Date
Recorded by
2043
PERMIT VALIDATION
PERMIT NO. y
DATE APPROVED I 4
EXPIRATION DATE
DATE' ISSUED y (9 `l
By — ��� , 3���
Administrative Authority
TELEPHONE: (619) 564-2246
0�
—TAN -2 I—S4 l= R a a 3
'NorE;�
Witt) proppi valid;IlioII
Nuevo ENG I NEER I NG
this foul, r�r,ctllulr s ru,
encioaelnncut I,r;rntit CI"fY OF LA OUINTA
Fnr thn
and nthPr
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
cnrr;Gnctir,u of I,uhlir. (11 l)liv;jte curi)s, driveways, pavements, sidewalks, parking lots, sewers, water mains
like I-Nic w,nks imlp0 v(!rnents in corri
.......%Lfyl 17111 L;Jass IV: See attached schedule Extended Page 2,1
'5JIPCfinii Fow
limit Fee PERMIT VALIDATION
PERMIT NO.
DePosit soll0v nrifill
DATE APPROVED
TOTAL; q EXPIRATION DATE
c0ill N,,, DATE ISSUED
-----------
ceived by
Date -By__
coldf-d by •Adinimistrative Authowlty
TELFPHONE: (619) 564-'224o
JAN -:2 1-<914 P R I 1 3: S<30 Nu E v O a" G I "a E R ING P_ 0 1
IN
79-811 COUNTRY CLUB
GENERAL ENGIP
NUEVO ENGINEERINGt INC.
0 BERMUDA DUNES, CA 92209 0 619/345-1778
3 CONTRACTOR - LICENSE NO. 438834
FAX' ( 519) 345=6704
FAX TRANSMITTAL SHEET
PLEASE DELIVER THE FOLLOWING PAGES TO:
NAME �Q f
FAX NUMBER: c)
.LOCATION:
FROM_ !
i
NUMBER OF 2AGES INCLUDING TRANSMITTAL
SHEET f
DATE: TIME_
IF YOU DO NOT RECEIVE ALL THE PAGES, PLEASE
CONTACT THIS OFFICE AS SOON AS POSSIBLE AT
THE ABOVE PHONE NUMBER'-
.