2195P 7TE:
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, criveways, 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 II
DATE: 6-1-94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Desert Crest Dr„ West of Dune Palms Rd.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Constructiaz Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Cat 623 scraper
DIMENSION OF INSTALLATION OR REMOVAL 13'8' wide
14' S" high 99' 6" Long
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6-1-•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:
HAUL ROUTE:
East on Desert Crest Dr. North
on Dune Palms Rd. West on Miles
to Washington St.
HAUL DATE: 6-1-94
PILOT CAR REQUIRED
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 cour9 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.
FORSTAN CO. P.
Name of Applicant (please print)
Sigg4f,dre 9;KAolicant or Agent
Business Address
Telephone No.
TOP CAT EQUIP.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
ON FILE ON FILE
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 10.
r �
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.
Receipt No.
Received by Date
Recorded by
PERMIT NO
2195
PERMIT VALIDATION
2195
DATE APPROVED 6-1-94
EXPIRATION DATE 6-1-94
DATE ISSPE1-94
By
';*tAdministrative Authority
TELEPHONE: (619) 564-2246
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