2191NOTE:
VIRth 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
DATE: 5-31-96
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Transportation Permit
DESCRIPTION OF CONSTRUCTION 245 Excavator
DIMENSION OF INSTALLATION OR REMOVAL WE 12'6"W
212.000 lbs.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
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:
Sketch (attach construction plans if appropriate)
HAUL ROUTE: DUNE PALMS TO MILES
TO CITY LIMITS (WASHINGCON)
HA4* DATE: 5-31-94
PILOT
13,994 Y
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from aid against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage t� persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. de
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 Agen
LARRY JACINTO CONSTRUCTION, P.O. BOX 615, MENTONE, CA (909)794-2151
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
45118
Contractor's License No.
CROSBY INS.?
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
2191
PERMIT VALIDATION
2191
DATE APPROVED 5-31-94
EXPIRATION DATE 5-31-94
DATE �ISUE5-3-94-94
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
N
MAY -31-94 TUE 9:17
P.O. Box 615
Mentone, California 92359
Telephone (909) 7942151
FAX (909) 794-9382
LICENSE NO. 450116
1
DATE:
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