2185)1\101i
2
With proper validation 04
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: 5-24-94
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit —Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Transportation Permit Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION C'�t/frTo�2— HAUL ROUTE: WASHINGTON ST. AT CITY
LIMITS SOUTH TO MILES EAST TO DUNE
PALMS.
DIMENSION OF INSTALLATION OR REMOVAL 16' H 121611W :5/,R 5-/ 9IC-E-roll
212,000 lbs. HAUL DATE:
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN PIWT CAS 0
x,11
APPROXIMATE TIME OF COMPLETION I�✓ I
ESTIMATED CONSTRUCTION COST $ MAY 2
1994 {
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction
om paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to: wy __ �J
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and aga nst any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to pers ns 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.
Signat re of Applicant or Agent
LARRY JACINTO CONSTRUCTION P.O. BOR 615, MENTONE, CA (909) 794-2151
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
45118
Contractor's License No.
CROSBY INS.
Business Address
Telephone No.
City Business License No.
BA 8147236
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.
$ 10.
Received by Date
PERMIT NO.
2185
PERMIT VALIDATION
2185
DATE APPROVED 5-24-94
EXPIRATION DATE 544,-94 6Z5.19y
DATE ISS E —24-94
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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MAYT24-94 TUE 10:10
4 n.
Al'TN:
COMPANY:
P.0- Box 615
Mentone, Californias 92359
Telephone (909) 794-2151
FAX (909) 794-9382
DATE: -
MESSAGE:
P, 01
LICENSE NO, 450118
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