2057,r
{U0TEZ
With proper validation 2
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
2/8/94Subdivision Improvement Permit — Class I II
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 16 G Blade Haul Route: Ave.58th to Madison,
1116"H,10'2" W,60,000 lbs Madison to Ave 54, Ave 54 to
Jefferson. North of City Limits.
DIMENSION OF INSTALLATION OR REMOVAL
Haul Dater 2/14/94
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 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 t e'result of this work.
b"r _ t7 �t
Signature of Applicant or Agent
Name of Applicant (please print) Business Address Telephone No.
Nuevo Engineering, Inc. 79-811 Country Club Dr. Bermuda Dunes, 345-1778
Name of Contractor and Job Foreman Business Address Telephone No.
On File
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 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 $ 10.00 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
$ 10.00
Date
Recorded by %_
24
PERMIT VAL
PERMIT NO. 2057
DATE APPROVED
2/8/94
EXPIRATION DATE 2/14/96
DATE SS Z
_'d.,
By �!
Administrative Authority
TELEPHONE: (619) 564-2246
FjEF3.— S-94 TUE 15:15 NUE V O ENGINEERING P. 02
ra;
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, wmer mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBOIVIS ONS
GATE: _. ,1S 9 `i
Subdivision Improvemertt Permit — Class III
Minot improvtmmt Permit Class IV 1�
LOCATION OF CONSTRUCTION
(Sliest address or Description of Loeationl
PURPOSE OF CONSTRUCTION Sketch (attach construction plans If appropriate)
- -
DIMENSION 01: INSTALLATION Oli REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL. 89GIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(including removal of all obstruction, mate0als, and debris, backfilling, conn
Psction and placing permanent resurfacing and/or replacing Improvementsl
In consideration of the granting of this permit, the applicant hereby agrees to;
Indemnify, defend and Save the City, its outhorlted *pants, olfic", rllisi'M tativel and gmployeel, harmless Iron and againtf any and all
penaftlet, liablllrles or lost resulting from claims or court action end arlSing out of any accident, fall or damage to Persons or praponv
happening or occurring as a p►o><IMAtg result of Any work undertaken under the ponnit prtntad pursuant to this application.
Notify the Administrative Authority of least twenty-four (211 hours In &&one* of the time when work will be Signed.
CornPly with all anoticable City Ordinances, the terms and conditions of the permit and All applicable rules and regul*tidnS of the City of
La Mints and to pay tot any additional replacernant necessary as the result of this work,
Signature of Applicant or Agent
Name of Applicant (please print) Business Address��'
Telephone No.
Blame of Contractor and Job Foreman Business Address
On File
Contractor's License No.
Telephone No,
YA 1 e
City Business License No,
Applicant's Insurance Company
Polley Number
FEl 8: Subdivision Improvement Permit —Class III
Public Improvements: 3% of estimated construction casts