2065n a, -NOTIE: i
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 Improvement Permit —Class I II
DATE: 2/1 S[94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Date Palm And Washingbbo
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION _ 623 Scraper
121W,Legal H, 65' Long, 119,000 lbs_ Haul route; Va6hington south bound
to Sagebrush east mound, to Date
DIMENSION OF INSTALLATION OR REMOVAL Palm and Sagebrush.
Haul Date: 2/16/94
SIZE OF EXCAVATION, IF NEEDED
AC"- L4
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 theiresult of this work.
' jnature of Applicant or Agent
Cattrac Construction 15030 Clover Ave. 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 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 III �D
Public improvements: 3% of estimated construction costs FEB 15 1994
l Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule 2V II.
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED c ' q Li
EXPIRATION DATE C ' 1G
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
I
uo
Subdiviiion`lmprovementIPermit Class III :_ •
ATlyf* .. 02 1'6/9.4 Minot Irripr•'.ovemaht Permit Cass IV.
LOCATION OF CONSTRUCTION DATE FAIiM, 4. WASHINGTON'
f$trest, address or Description 01 Zoiiatlonl 77
PURPOSI •OP CONSTRUCTION Sketch (attach contupt ion 010ns if appropHatej.
. btSCRIP.TION'OF CONSTRUCTION TRANSPORTATION PERMIT
.. LOAD; ':.-6 2 3 SCRAPER
bIMENSION OF INSTALLATION OR REMOVAL DIMENSIONS LEGS, HEIGHT; •
' J2.1 . WI -DE.; 6 5 t .LQNG ..
.GROSS.. WEIG4T: 11.9 r 0,00 #..' .
SIZE-OFEXCAVATION, IF NEEDED ORIGI.Nt:. •NORTH CITY LNtITS .'
- - DESTINATION $ DATE .PALM .. & .
APPROXIMAtE TIME WHEN WORK WILL BEGIN S "
S)kGEBRU'SFi
ROUTE,;:. ; . WA�HiNGTON.' S/B• -�
APPROXIMATETIME OF COMPLETION=— - SAGBRUsii
ESTIMATED dONBTRUCTION•COST'S
f Indi4ri p removal of all obstruction, materials, and debrls, backfilling, com. i.
pection and placing permanent resurfacing and/or repla(cing iml)rovemenis)
In. contideratior: of-ttte ,granting of this permit,, the applicant. hereby,.egrees ta;
tndemnrfy, defend land:save tfie City, its atj or.iied events; officers, representatfvaa end empioY;as. harmless from ang apainst-anY..and all .:
penabie's,•IieblllUei: of loss ►esuttino from clialms or court agtion and arlsittq out of any. accident, Ions or damage 1oIpersons or property'
happen+n$ of occurring as a proximate result o1 any wp'rk'•uridegtiken under ths.•partnit granted pursuant to this app9�tat�on:
Notify the Administrative Authority at feast twenty-four. i341 hours in advance of thelima when work will ba staNttd.
Coriip"iy'uvlth all' splif(cable City Ordinances, tfje terms and condition's of the permit and all-apc+llcobla.ruies'and regulations of the -City. -of
La 6ulnia and to pay for any additional replicement neee;seary as tlia result of. tbl .work.
(' .. Signature of icant-or AEent: .
. Inc,� 1 lover Aixe., Faii _ 6
Name of Appilcant Ipiease' print) Businestt Address' . Telephona No, I
Ntirrte cf Contra
ctor and.atib Foreman 801ness Address,.,
•,. CotitrAcior'c License Nti.. � � �' .
City gUfllness,l.icense.No. - � �
Appllcant's.'lnsurance Company '
• .pollcy;Numb r -
i. . F.E0S. SubdiOsion lmpiovement Permit = Clan III
I ••
'' ' pr,f,Ili" ir�iniAVgmiartte � E �Qtirript»rl anrt+rfnirt�lrin.rri�t; •
(' •'�.:rw HI!wlUVyjI140„►b, . ,u w as�nf'igttl/l CVIIbl1UU't'1ti11.MV>tl>j,. .
Mirior.improyemt'snt Permit — Class IV:, See attached schedule NOM
„�.
•I
Ir►sI*Ct'*1on. Fee : $
PERMIT .VAL106iION
Permit F.eis
PERMfT:NO.
Cash Depbsit=Surety Bond. DATE: -APPROVED
s,
if.`repulred .^, EkPLRATION f)ATE..:..;.: ...
tOT
i.. .DATE ISSUE'
Received Date BY
�.
Adrrtiinistrative Authority .
Recorded by .:
Tt LEPHO.NE:.(BT.p). 664.2246
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