1483 (2)NOTE:
M
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
DATE: June 16, 1992
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit - Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate) (
DESCRIPTION OF CONSTRUCTION Conveyor - Tow
11'10" Wide, 85' long; 15' high Haul Route: Avenue 52 and Washington
East on 52 to City Limits
DIMENSION OF INSTALLATION,OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Haul Date: 6/11/92
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:
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and. all*
'° r'r 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.
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Signature of Appl.'c nt or Agent
Tarmac California P.O. Box 14050 Palm Desert, CA 92255 775-8267
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman - Business Address Telephone No.
'On File On File
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$ 10.00
Receipt No.
Received by y Date
1463
PERMIT VALIDATION
PERMIT NO. 1483
DATE APPROVED 6/16/92
EXPIRATION DATE _6/1/92
DATE ISSUED 6/16/92
By 4tll-
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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R •nvLra�,..tor,�:, CITY OF LA CIUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS 'CO►sSnU.CTION (ENCROAGIMEKT)
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rna otn•r Ilk• pt1�IK >rkr fmrrvr+rr nn to mr?rw=an with MINOR IMPROVEMENTS rnd APPROVED
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