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2108NOTE: 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 DATE: 3/23/94 LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Move Equipment DESCRIPTION OF CONSTRUCTION Cat 623 B WTR PULL DIMENSION OF INSTALLATION OR REMOVAL 14'6"H,12% 70% 65,000 lbs SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Subdivision Improvement Permit — Class 111 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) Haul Route: Jefferson St. south to 48th Ave. Haul Date: Pilot Car Req d MAR 2 4 1994 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. Signature of Applicant or Agent Forstan Co,Inc. P.O.Box 625 Colton, CA 92324 (909) 871-2126 Name of Applicant (please print) Business Address Telephone No. Allen Wood Equipment Rental Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business License No. Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class II I 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 $ 9.0.00 $ 10.00 Date 2j08 PERMIT VALIDATION PERMIT NO. 2108 DATE APPROVED 3/23/94 EXPI RATION DATE 31 Q L,1 1 C� Ll DATE ISSUED H1�� L4 By - Administrative Authority TELEPHONE: (619) 564-2246 I- '�,''- � gree aW°° I�ttiu�e �o %i onuwra►oaWi 01i4►W • III a*i� � ijWNr p+tlwAo�OWI uoauupang ;�3i1� Rg1WfN A�lIO�I AUNWO* touuft+ul •,ivr3,rojv 'ON m+Mii 10ow:ww0 �! itl ttr tta� u d 4oP Put MW'U OO W SWIN VN Nl / 7-� V 1r'�' va►' n Q�o�rJ �i 7-74y mr.VIw�e tn.Idj �uoslpt,d 16 •�.N �wiy A x+�lpav � � WAN 14 1" 4+w Wye PAR bA p t*etm w M" 091 MM 10 A+IRq*e &vpuWvP"V RLP AJPON 'MIIM� tlils N iMSwM /HllM HYMIM t10 MMt11 Y/;plNdll ASN Io 1{eW MtgiM 4 N 1rw�o e� W�uv AlAm" N mom at dem ae VAL-Vwmm ILII to U� wgif/f � MMisA/=- l� IueNi7 uiW{ M�I:lA11u MI A MSI{i�.7!! 'WlAwv IM NN Arrt il�lllt R1M + MHWfiF'�MAt1M1Y1 tYt rilelrttNdr tom* "M@k M+WMM Bfl �NIO Md IMIt P4 ► N WARM1 :01 Muk AAIWW 1101100 Nip 111w 0 1441 !+o kq&U A pA Ie uegtatplwo* ul IM44mmAwduq &WOW Ao/put dup*ynsu WOUWWAd $up" OWN uop!Mo C/�riL+. -�.�� off, IINIt+A'�+gtp PWt'titliptW •Rel qo Ilt �o IMOWW 1wP�+11 v , C! $ Alm NouzMWI OD a11w"UAa .jldviQ2 do gnu Aivnixomdo NIDl11�W1 xIAOM NPIWt Itw11 UVPIlxoMAOY 080RIN dl'NOIIVAVDXS d01=I1 VUG#rj7 7 -SFivAOMIM MO N0l1V IIVJSNI do NOIoomi0 Iry _dJ717 1401421M1MUN60 do N01,1dIUMO iAM1bON0{}t �I �+eld u01v1�iYW :pgirl , L rte„ d, ��ou/ NOLMN"N00 d0 I KWwnd ') le UM&M0a0 n MOO/ a"$, ?I AE /vos,��� „� Not�?I1MtMN0o d0 N©1111JOi '_"_'�'' AI Mq �d tlltuwep�lurt M :3t�ro 111 O4 — sNuty WOUMU MI � b + �' r� tlNpt�lAtaNf'q 01IAOM�1i Pw �iN�W�AQMdW1 IIONII� �iAt W t teo :�l t:iwr� ql f 141, mme put "M J%lm 'tam "" I'Wid '$*WPIN ' ate 't+►aMMVP IW --d anulad A 9jAhd +O MQWMUav 141 rod .ti.l► inb ,," d0 Alb �uual w.Wcptoac::t ut a1MIWQ7 ur,q �,a uoptgllM ROOM W+M