2101NOTti:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit a
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
DAT9115/94
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment
DESCRIPTION OF CONSTRUCTION 14D 240 Backhoe
12'W, 65%, 115,000 lbs
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
.k
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit —Class I II
Minor Improvement Permit Class IV
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)
Route: Washington and Eisenhover to
Vista Laguna and enhower from
North City Li
tsO
q
ey`���� 4i
Haul Date 3/15 `4,
P► Lo ; - C V) K Ic��
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 propee rty
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. ►+s
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 his work. If
Signature of Applicant or Agent
CATTRAC Construction 15030 Slover Ave, Fontana CA 92335 (909) 355-1146
Name of Applicant (please print) Business Address Telephone No.
Name of Contl'actor and Job Foreman
CD -� (' I <
Business Address
Contractor's License No. City Business Li
Telephone No.
L N) �_ ( I P U r'1 Z -- I( n
Applicant's In urance Company Policy Numller
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:
Receipt No.
Received by
Recorded by
10.00
$ 10.00
Date
2101
PERMIT VALIDATION
PERMIT NO. 2101
DATE APPROVED 3/14/94
EXPIRATION DATE
3/15/94
DATE ISSUED 3/14/94
By .
dive
"ministratAuthority
TELEPHONE: (619) 564-2246
Subdivision Improvement Permit — Class I It
Minor Improvement Permit Class IV
LOCATION OF CO STRUCTION
IStreet addressor Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
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, corn.
paction and placing permanent resurfacing and/or replacing improvements{
Sketch (attach construction plans it appropriate)
TRANSPORTATION'PERMIT
LOAD: MD 240 BACKHOE
DIMENSIONS: Legal Height, 12' Wid<
65' Long
WEIGHT: 115,000 lbs
ORIGIN: North City Limits
DESTINATION: Vista Laguna &
Eisenhower
ROUTE: Washington & Eisenhower to
destination
In consideranor of - the granting of this perrnit, the applicant horeby agrees tc.:
Indemnify, defend 'and save the City, its authotiied agents, officers, representatives and amoloyeas, harmless from and against any and all
Penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss n damage n persons or property
happening or occurring is a proximate result of any work undertaken under tha permit granted pursuant d this Application.
Persons
s
Notify the Administrative Authority at least twenty-four 1241 hours in advance of the time when work will be started.
Comply with ail appl,cabfe City Ordinances, the terms and conditions of the permit
La Quints and to pay for any additional replacement necessary as the result of this.
Name of Applicant (please print)
Signature of
Business Address
all applicable rules and regulations of the City of
k. 1% • /
or Agent
Telephone No.
Name of Contractor and Job Foreman
Business Address Telephone No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company
:mss: Policy Number
FEES, Subdivision Improvement Permit— Class III-------------
t',,hlir imnrovemenrr oat ..s rtirnarorl rnnctritrti^n r.^,k
•-�- •...r Vrvnwifw. v , v, oouuIdlCu WIPAI AIUrt -_vbta
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
.TOTAL: $
Receipt No.
Received by Date _
Recorded by
Z d
v�
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564.2246
oNI mono dismoD
b61 --p T NidW— —
6
NOTE:. ;
With proper; validation
this•form co;nsfitutes:an
encroachm9nt permit CITY OF LA QUINTA
i
APF�h'ICATION: FORPERMIT
PUBLIC WORKS CONSTRUCTION: (ENCROACHMENT) .
For . the.' construction ofpublic or private curbs, drivewa s
, Pavements, sidewalks, parking Io S,: sewers� water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS a d APPROVED SUBDIVISIONS
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