2158N%je: -
t; 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: 5-2-94
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Buipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 225 Cat Excavator
DIMENSION OF INSTALLATION OR REMOVAL 10'5" M 50,0001be
SIZE OF EXCAVATION, IF NEEDED
Haul Route: Washington to 52 to
Jefferson to 54 to Madison to 58
to " The Quarry "
APPROXIMATE TIME WHEN WORK WILL BEGIN Haul Data: 5-2-94
Return on aaae route 5-4-94
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:
(2) trips
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.
re of Applicant or Agent
Waltons Backhoe Service 345- 5212
Name of Applicant (please print) Business Address Telephone No.
Piconi Trucking 345-5212
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III i
Public improvements: 3% of estimated construction
Private improvements: 3% of estimated construction
Minor Improvement Permit — Class IV: See attached
3y.
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
20
$ 20
Receipt No.
Received by Date
Recorded by
2158
PERMIT VALIDATION
PERMIT NO. 2158
DATE APPROVED 5-2-94
EXPIRATION DATE 5-4-94
DATE ISSU, ED 5-9-04
By
Administrative Authority
TELEPHONE: (619) 564-2246
>�
�.. r,,�. -. _
NOTE:
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, sewer, waternuiew,
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISION,
DATE: %
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class 111
Minor Improvement Permit Class IV
(Street attdreaa or 0 of Location)
PURPOSE OF CONSTRUCTION A-'7—✓��
rA Sketch lattach con coon plans if apprpp�d',.
Vc
DESCRIPTION OF CONSTRUCTION iS7tAt_ .0 £L TQClf �S) Ars! D-bdr--8-eb h �� 0 � a /- C (/13,%�%e
H-t� fi'
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCt:VATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction, materials, and debris, bat -*filling, eom.
paction and placing permanent resurfacing and/or replacing improvements)
W,OS H/ i✓Gj 7V A/ v; -*' 5
A,/ S�,Z A k1,-hL6 / s o/✓
vE,
Qc c,A-7�
IZAc,e
$14 /f�
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemmfv, defend and cava the City, its authorized agents, officers, representatives and amPloyNs, harmless from and against any and NI
Penalties, liabilitiq or Ions 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 leant twentyfour 1241 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 ruin and regulations of the City of
La Quinn and to pay for any additional rePlaprNnt naceaaary as the result of this work.
� f APplicant (please print) n /,
/ C N �-2�a1 /✓
Name of Contractor and Job F Oman
e -A /e
Contractor's License No.
Applicant's Insurance Company
Signature of Applicant or Agent
-// / <_&- --3gf5- 5
Business AddressTelephone No.
�S-7J�
nusineu Address Telephone No.
nA) A /e
City Business License No.
Policy Number
FEES! Subdivisinn Imnrnver+ant Permit — rias, Ill
Date:
S M T W TH F S
_ e
City of La Quinta'
Public Works Engineering Department
Inspector's Daily Log
Commercial/Residential Development
Weather: Clear ❑ Cloudy X Rainy ❑ Overcast ❑ '
Temperature Range: 45— Wind: Still ❑ Moderate X High ❑
L,1 f A / .. T i,�f T c i� i Y,e c..�.c.7 *-i7'a {-exC
By: Title:c S J r
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CADoeurnents and Settings\jrey\I.ocat Settings\Temporary Internet File's\OLK2811)\Daily inspectors Log.doc