2188NOTE:
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
Subdivision Improvement Permit - Class I I I
DATE: 5-27-94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION WASHINGTON & CALLE TAMPICO
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION TRANSPORT OVERSIZE LOAD Sketch (attach construction plans if appropriate)
CAT 623 SCRAPER
DESCRIPTION OF CONSTRUCTION HAUL ROUTE: FROM CITY LIMITS
ON WASHINGTON TO TAMPICO.
DIMENSION OF INSTALLATION OR REMOVAL 121W 1416" H
65' L Purple weight HAUL DATE: 5-27-94��
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION Q
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 app icant hereby agrees to:
Indemnify, defend and save the City, its authorized agems, 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.
MARCO RENTALS 3636
Name of Applicant (please print)
✓/Signature ofdNip-plicant or Agent
SANTA ANA, CA
Business Address
714) 554-5930
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Cal. 158746
Contractor's License No. City Business License No.
Seingi - Hannon QBN85443721
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit -Class III
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
/40
$ �0
Date
2188
PERMIT VALIDATION
PERMIT NO. 2188
DATE APPROVED =J" ARM !2 -7
EXPIRATION DATE6',o-P 7 _9
DATE ISSUED' -Z7
r
By '&,�_
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
" SENT'BYtXerox Telecopier 7020 ; 5.25-94 ; 8.41AIA ;
I
16�9'1'fr'r�ul-� rla ooa oa;��cis r
NOTA:
With vroper vaildetlen
this form aaaltltnel an CITY OF LA CIUINTA
ant70ef#tfnlrM Anflffk
APPLICATION FOR PIRMIT
PUBLIC WORKS CONWILICTION iENCROACNMENTI
I
i
per the aintttumt ", of polie or private curbs, driveureyv, pavemanter sidewslk", parkins lot;, waren, wstst ri"Im
and other like public works it etmvements in conneetl®(j with MINOR IMPROVftMENTO and APPROVED SUBDIVISIONS
A l I Subdivision lmpmvernsm Permit — Clap III
DATEI I� ` 1 ALJ Mlw Improvemom rumlt Gels IVAll
�...._......
LOCATION OF CONSTRUCTION
I •
f2um "ods» or DawAi Won of Loestbnl
PUL) OSE OF NSTR ON IBJ _ Sketch fettech construction pian" If spprppristal
011SCRiPTION OP CONSTRUCTION
DIMFNSIqN oo INSTALLATION OR r'VRI L, -
SIZE OF EXCAVATION, IF N11bED
APPROXIMATE TIME WHIN WORK WILL BEGIN
A"FIOXIMATE TIME OF COMPLITION
ESTIMAIN CONSTRUCTION COSTS
Onatvdinq rstfklvel of ell obstruction, mstarlsts, and dsbfb, badtfilldap, oem. 1
paetlon and 1314661 WfPU" resurfidnq And/or rappels® impMverr,")
' In eomildumlen of the granting of tills panus, the sppligmt hereby atireee to:
Ind.ronlh,•d*fara errs sera V* City, Its eutherlaae atlthta, oPllterb IWf mmtivn and eo.ploy M. hfufrrlra trots IN against anti eft/ NI
prhettfal, italtAHln 9r lop rewitinq from idslnts' a ootat sedan entf VMnq out of any avaldarik lois w damage to aMdM or propeity
hapoanirq 0, Ada 111"" As a "Im m nark of INV warp wwwufna vhdlr the 00MA stented puraysnt 10 thla amllration.
Nottty ote AdminitsntiW Autherlty at 1W tf ffl*four 1211 iWwl in drams of the tarot whew w6 A vAll be rA?l:W
e4mply with all saplf"eis easy ordinerfe s, the annl and aoMMOM of the 000011 rod Ali IMIaMs fvias Ind PW*tkna of the Oily of
Le Olylefa end to pay for I" "dlfitional rtp!aaamIllit AVO MW ai *0 fault of thtl www
i
Blame of
x
Name of
I
X .—(
Llcetts
and Job For.ntat
M AppiNant or Aomt
Buslnep
Buslnele Addrael
City Baia u Llemea
No.
A 1lieant's Il"Urana Company t5ktvti, L..I,00tLiTy Policy Nlmtbw
ai11Ii1: SuEtinl"Ion Improvemm�Perinit —Cts"" III
err
Public Improvements: 3% of ectirfNtod conatructlon costs ,3 8
Private hnpr lvarowmi 3% of sa lw4. tW edhmcrtion cwu
Minor Imorovamerit PaMHt — Clem Sae stwoltod schedule
Insoection Pie ! P114MiT VALIDATION
l
Permit Fw PARMIT NO,
Penalty �- -- — DATE APPROVED —
; Cash Dspesit•Sursty Bond
If required EXPIRATION DATE
I TOTAL; 1
DATA ISSUED
Receipt No.
Sy
aloolved by Date— Adminisua dw Autttorky
fI
-t