2109-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 III
DATE: 3/24/94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION CAT 623 Scraper
Haul Route: Jefferson St south to
48th Ave.
DIMENSION OF INSTALLATION OR REMOVAL 14'6"H,12'W.
65'L. 60,000lbs
SIZE OF EXCAVATION, IF NEEDED Haul Date: 3/24/94
Pilot Car REquired
APPROXIMATE TIME WHEN WORK WILL BEGIN
QAPPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com DMAR 2 41994
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to: y I
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.
Signatur ,,of Applicant or Agent
Forstan Co,Inc. P.O.box 625 Colton, CA 92324 (,909)877-2126
Name of Applicant (please print) Business Address Telephone No.
Allen Wood Equipment ReUll
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 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.
10.00
Received by Date
2109
PERMIT VALIDATION
PERMIT NO. 2109
DATE APPROVED 3/24/94
EXPIRATION DATE
DATE ISSUED 1 a
By
Recorded by 11 TELEPHONE: (619) 564-2246
ministrative Authority
r,-7.
__ qws wAM►rMuq P+a<IWI>tiRR {e � uww�ruioa0w! K�l�
Xi IIWRwat►eJmuII DAN
NuuW WPWGJdWi uoilimpans :gI34
ARMIN A0I0111 A00woo Iaulunjul s,Iu.oitdaq
'aN �pl'1 IwuiNR9 AIS
*IIN e+m"Ill
'eN mumn I,Jose alwa
VWMd qOr Pul Jowr woD p aweN
�N 1-- '
1] ( MgId) lupllddr io
wdy a ww� 16 x cIIfc7
'AJM M+A so Oftw —v+a w •mow mmagow wR qi AN w sw mul,ip TI
M WIN
"W" "Al Rnm" to me van Kp it W*" we awp qi '%wmwwcj AIm Immma in wo NO&"
,el+erlR " M* "m W" Am MA is mow w W" 1"I JMU•MwMa; I" a A1iJ v wwwulwp'o eta 4"00
'MOMM $I* a 1WIWM NNWil wwm 0* AWA vmj%m6 bow ImI�Irlre / M IuuJAloa n Wwatl��
euwee a IMM a• +IAI 'W@plW MR ie p+s &M" pa Von &*",* IW;iiO wrN� at+ml+w+ MI q ulaw"011.4 ums"%
iM /w AtN iNrleR� /Ye wr•Ji wMw�AY'IMAMMu1 we �1111M1MiM 'WM�yI )NMI pumiaN n 04* app a>w rw SNP 'M'Wswl
:oR
MAN A"64 tuallpde eIp 'ZtWNd 410 A 64ty > NA it uenuaplwm ui
021w1
" -"2y `4') 7 Q -7d
H -J- 0ps>
Raul W""" APO 1UP14 V wfueWJld Wp olo pw uoamq
ORio'6 gwIMRR4'4" PuR 'IiItNMit 'uopeey�go I1R {o IIA"IU IYIPOOUI)
II low Noumwj>eNo:) GlAwMi usa
NDLLXWVM do Intl uvwlx0m,"W
r— 7 NIOIs1-nim )IVCM NlMM IWIt UVWIXOYm'
QIOtIIN O'NOLLVAMS 40 HIS
_ f� NOIMUNoD do Nau�dll�C
.,.�.�...._.,,..-
1%4MOtOM {I wRld u010fimm IPIUl) 41191 �� n NOl,1,011Id1�Npa >d0 ��Odl:�r
IwIRRn is usaawM a is =WM@ Wall
1S% !�'os-d�a�a,�' NOuanwalloo dO NOIlr001
"�..•� Al WO *WW UWAE AKUI MO
III IIS U� WOW mou"AWINI UPOPIPWO 41
SWISIAI4fM OtAQaddV 111+ lMWIAWRI VONIw IPIAI► uOptlFnW 1Jt auhmmaxhiq vil" plgnd o4p ilkne Pue
NO" JIIIRI 'aJRJ1ARR 'q�l 6WIIMd 'R>p plR 'puIoINARd hAIMN1yJd 'Rgilq IuM�d JO o114nd {e wvllatiasuw e+A +od
liNBINMavotima) 1101 ilaw Imilom. oll®nd'
IJNNBd :UOd 'NO14MIddM.
. ilk MID 'Vl, 00 A ld �u+ne wlwwevrrue
w ewmuuee wJq qW
' �I1sPIIW► JadQJd tAilyj
i0d IZ117IL817T.L 00 NOiSNOJ il:OZ TOc 9T NkOr