21753TllIl,
th. 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: 5-18-94
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Corner of Milers and Dune Palma
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Low Bed 14—G Blade
H.W. The all lesad
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, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
HAUL ROUTE: DUNE PALMS TO MILES WEST
TO JEFFERSON
HAUL DATE: 5-/,,;4
Mq r
By 8 1994��
U►
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
Ile
Top Cat Equipmenty 2400 West Baseline, San Bernadino (909) 888-6332
Name of Applicant (please print) Business Address Telephone No.
Century Homes
Name of Contractor and Job Foreman Business Address Telephone No.
on file
Contractor's License No.
op file
on file
City Business License No.
on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I 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.
10.
$ 10.
Received by Date
PERMIT NO.
2175
PERMIT VALIDATION
2175
DATE APPROVED 5-18-94
EXPIRATION DATE
5-18-94
DATE IS UE 5 8-94
By jL�� Xl:,, re��
D Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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