0535NOTE:
With proper validation
this form constitutes an.
encroachment permit
n
CITY OF LA QUINTA
APPLICATION • FOR PERMIT
-PUBLIC, WORKS'CONSTRUCTION (ENCROACHMENT),
�{ ONE TRIP'HAUL 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
Subdivision Improvement Permit— Class III
DATE: 3/20/90 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Bermudas Avenue/La Quinta '
(Street address or Description of Location) '
PURPOSE'OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION HAUL ROUTE:'r WASHINGTON TO
EISENHOWER TO BERMUDAS
t
DIMENSION OF INSTALLATION,OR REMOVAL' Fkomaca crri ndpr
all legal , exc'ent •9 ! 6" wick? .
SIZE•OF°EXCAVATION, IF NEEDED
?APPROXIMATE TIME WHEN WORK WILL BEGIN
}
APPROXIMATE TIME:OF COMPLETION 3%an/9n `
ESTIMATEb.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
o-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 iules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
• Signature dfApplicant or Agent A .
Massey Said and Mock PO Box 1767 Indio.•CA 92201 775-8200
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. -
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs np5i8" ��5q p3— 0-90 ��
1U FASR ? •ifI *R1 10.00
Private improvements: 3% of.estimated construction costs '
'
Minor 'Improvement Permit —Class IV: See attached schedule b`'i2' 0535
Inspection Fee $
Permit.Fee I n1 no
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 1 n . n'n
Date
PERMIT VALIDATION
PERMIT' N0: 0535
4
DATE APPROVED- 3120/90
EXPIRATION DATE 3/2ID/90
DATE,ISSUED 3/20./90
By T
Administrative Authority
TELEPHONE: (619) 564-2246 >
NOTE: J
With proper validation cZ 2
this form constitutes an
CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT -
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)�� '• �Sw�ti
ONE TRIP HAUL PERMIT OF TN89
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
3/20/90 Subdivision Improvement Permit — Class III
DATE: " Minor Improvement Permit'Class IV
LOCATION OF CONSTRUCTION Bermudas Avenue/La Quinta
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION. Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION HAUL ROUTE: WASHINGTON TO
EISENHOWER TO BERMUDAS
DIMENSION OF INSTALLATION OR REMOVAL Bomaa grinder
all legal, except 906" wide
SIZE OF EXCAVATION, IF NEEDED,
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/20/90
APPROXIMATE TIME OF COMPLETION 3/20/90
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 tothis 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
offsf, this work.
{Jj /+
' , w- � !.A! � tel{ +��`it�'�y����e%��. •
!!!Signature of -Applicant or Agent
Massey Sand and Rock PO Box 1767 Indio /CA 92201 775-8200
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.
Applicant's,lnsurance 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
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
�.r TOTAL: $ 10.00
Receipt No.
Received by Date _
Recorded by
0SiBWkHp ?%TRL-iO_.�0 i0.0pi0
4N- 0535
PERMIT VALIDATION
0535
PERMIT NO.
DATE APPROVED
3/20/90
3/20/90
EXPIRATION DATE
3/20/90
DATE ISSUE'
By f /
Administrative Authority
TELEPHONE: (619) 564-2246
c+
• ''kms. _ ... '
NOTE:
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
` �j Subdivision Improvement Permit
DATE: 3 G Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans.if appropriate)
DESCRIPTION OF CONSTRUCTION. .
DIMENSION OF INSTALLATION.OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
- rfio L.sr
i
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Inc!uding removal, and debris, bac fiiling, 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 124) 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 Appli or Agent..
Name of Applicant (please print) Business Address Telephone No.
v S'A /d k-ock
Name of Contractor and Job Foreman Business Address Telephone No. '
Contractor's License No. 'City Business License No.
Applicant's Insurance Company • Policy Number
FEES: Subdivision Improvement Permit —Class ill
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs NO
Minor Improvement Permit — Class IV: See attached schedule lr
Inspection Fee $ II PERMIT VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
Received by
Recorded by
Date
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative- Authority
TELEPHONE: (619) 564-2246