1181� �; r4r '-•roti"?�` ' � a ,..- • ,
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NOTE:
With 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
j Subdivision Improvement Permit — Class III
f DATE: AuMist 12: 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION r
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION move equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION �, �Z� ��
j... _ f1n?EjC HAUL ROUTE;
" FROM WASHINGTON AND TAMPICO
DIMENSION.OF.INSTALLATI(N OR REMOVAL r N/B TO HWY 111 TO CITY LIMITS
HAUL DATE; 8-13-91
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)
1n considerati6n-of.the granting of this permit, the applicant hereby agrees to:
Indemnify, -defend and save the`City, its authorized agents, officers, representatives and employees, harmless from and against any and all
I penalties, liabilities or loss resulting from claims or court action.and arising out of any accident, loss or damage to persons or property
V happening or occurring as a proximateresult of any work undertaken under the permit granted pursuant to this application.
• Notify the Administrative Authority at least •twenty-four (24) hours inadvance of the time when %vork 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.
# �Signa�t/ore of -Applicant or Agent
—__FICONI•TRUCKING 39723 OLD CARRIAGE RD,.MURRIETA CA 92362 677-8196
Name of Applicant (please print) Business Address Telephone No.
NUEVO ENGINEERING INC 79 -811 -COUNTRY CLUB DR BERMUDA DUNES 345-1778
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE "
' ONFIEEE
Contractor's License No. City Business License No.
ON -FILE `
Applicant's Insurance Company ,, Policy Number
FEES: Subdivision Improvement Permit — Class Ill '
005 0 3�7q 08-0--91
02_ 3Q -T
" Public improvements: 3% of estimated construction costs i0 A 00
L i 10.
Private improvements: 3% of estimated construction costs U fFll
Minor Improvement Permit — Class_IV: See attached schedule
Inspection Fee $ I PERMIT VALIDATION
10.00
Permit Fee1 1
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$ 10.00
Receipt No.
Received by Date
PERMIT NO. R1
DATE APPROVED 9-13-91
9-13-91
EXPIRATION DATE
D TE SU 9+13— 91
I.
By
Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
i0
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f ,�,�>.
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T
F
NOT&:
%,_With 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
August 12, 1991 Subdivision Improvement Permit — Class 111
DATE: Minor Improvement Permit Class IV —
LOCATION OF CONSTRUCTION
(Street address or Description of Locatloitl
PURPOSE OF CONSTRUCTION - Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 824C Dozer HAUL ROUTE:
From Washington & Tampico
`DIMENSION OF INSTALLATION OR REMOVAL 13 t H, 13 t 911 -
LBS W; N/B to l Hwy 111 to City Limits
97.000
SIZE OF EXCAVATION, IF NEEDED
HAUL DATE:
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:
8-13-91
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 (241 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 Ouinta and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
..Pi (()nj.. `T_rucki na -Q723 Old Carr_i8_gM11rr. i-PL,2 (-.A
Name -of Applicant (please print) l .1f
Business Address Telephone No.
NPri nfr, 1r1C ly—fj1 1 Country Cl uh T)r T�Pr1711Jf1A I)UnPS �llr� 17713
Name of Contractor and Job Foreman Business Address
Telephone No.
On File On File
Contractor's License No. City Business License No.
On Pi -I P
Applicants 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
nspection Fee
'ermit Fee
Penalty
:ash Deposit -Surety Bond
` required
TOTAL: $
leceipt No.
deceived by Date
iecorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: 16191564.2248