1191NOTE:
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
DATE: A-1 9-91
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV -
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE EOUIPMM, Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 9150 CASE FARM TRACTOR
DIMENSION OF INSTALLATION OR REMOVAL LEGAL HEIGHT
13'6" LEGAL WEIGHT
SIZE OF EXCAVATION, IF NEEDED
M
APPROXIMATE TIME WHEN WORK WILL BEGIN
HAUL ROUTE:
WASHINGTON & TAMPICO INTERSECTION N/B
ON WASHINGTON TO CITY LIMITS
HAUL DATE: 8-20-91
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:
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 (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 ApJlicant dr Agent
PICONI TRUCKING 39723 OLD CARRIAGE RD MURAIETA, CA 92362 714-677-8196
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
Contractor's License No. City Business License No.
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 P,er""mit -- Class IV: See attached schedule
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
1 11
Receipt No.
Received by Date
1
gg 119�55
i0005ie2 40 3108 A 08 19-9 10.00 10
PERMIT VALIDATION
PERMIT -NO. > > Q1
DATE APPROVED 8-19-91
EXPIRATION DATE S 2^ 9
DATE E — Q—Q
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
i
.L�-.
�. ��
`�
.. -
NOTE'With;or validation
this °form constitutes an
encroachment permit
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
CITY OF LAI QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
DATE:Zjjqjqj
—
Subdivision Improvement Permit — Class III
Minor Improvement Pe --------
.LOCATION OF CONSTRUCTION rmlt Class IV
(Street address or Description of Location))
PURPOSE OF CONSTRUCTION
Sketch (attach construction plans if appro tial )
DESCW19N OF CONSTRUCTION
DIMSr10NIOF IgSTALL� TION OR REMOVAL
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 deb: -is, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements►
I
r016 rtU
til �tla�Vl,�h�-Fo� �o
In consideration 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
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 811 applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quints and to pay for any additional replacement necessary as the result of this work.
Signature of Apl can r Agent
..Pir.nni,_`hruckinV—_�Q,7_�� nlr� C,r�;1
Name of Applicant (please print) ! _
Business Address Tele
El—- ._ _ phone No. 16
Name of Contractor and Job Foreman
On File
Contractor's License No.
On Fi1P
Applicant's Insurance Company
IFEES:
Business Address Telephone No.
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
t Fee
'enalty
:ash Deposit -Surety Bond
'required
TOTAL: $
teceipt No.
tecelved by
Date
Iecorded by
On File
City Business License No.
Policy Number
�O
PERMIT. VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246