05394
NOTE:
With proper validation
this form constitutes an
..
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE LOAD PERMIT
N
For th•e 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 I II
DATE: Minor Improvement Permit Class IV .
LOCATION OF CONSTRUCTION Hwy 111, S on Washington, E .on Aven 52 1/4 mile
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Cat 14C Loader/ HAUL: ROUTE: Hwy 111 to`
Grader 1015". *aaalkaMpal width/length Washington, South on Washington
to Avenue 521,Eatt on Avenue
DIMENSION OF INSTALLATION OR REMOVAL 52_1/4° mile
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/22/90 _
APPROXIMATE TIME OF COMPLETION 3/22/90
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
pactiori 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, harmlessfromand 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. 1
Signature of. Applicant or Agent
•r
Schwab Sales.- 195 E Warner Rd Chandler, AZ
-.Name of Applicant (please print) Business Address Telephone No.
Cal Permits
r
Name of Contractor and Job Foreman Business Address Telephone No.
}
Contractor's License No. City Business License No. ,
.Applicant's Insurance Company
FEES: Subdivision Improvement Permit — Class II I
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
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
Policy Number 29�q 03F-12-90 g'4
00100 :, �,Q . I TAI S iQ 00
053.9
a
PERMIT VALIDATION
0539
PERMIT NO.
DATE APPROVED 3/22/90
EXPIRATION DATE 3/22/90
DATE ISSUED� /i 3/2.2,0
By—
Administrative Authority
TELEPHONE: (619) 564-2246
(10
wq r r.qy .
NOTE:
With proper validation
this form constitutes an
encroachments permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE LOAD 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
i
Subdivision Improvement Permit — Class I I I
DATE:, Minor ImprovementPermit Class IV
LOCATION OF CONSTRUCTION Hwy 111, S on Washington, E on Aven 52 1/4 mile
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Cat 14G Loader/ HAUL ROUTE: Hwy 111 to
grader 1015 *aak4AQAhnal width/length Washington, South on Washington
to Avenue 52, Eatt on Avenue
DIMENSION OF INSTALLATION OR REMOVAL 52 1/4 mile
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/22/90
APPROXIMATE TIME OF COMPLETION 3/22/90
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 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 Applicant or Agent
Schwab Sales 195 E Warner Rd Chandler, AZ
Name of Applicant (please print) Business Address Telephone No.
Cal Permits
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10.00
10.00
Received by Date
Recorded by
Policy.
hyeAN- 0539
PERMIT VALIDATION
0539
PERMIT NO.
14
i o . 00
DATE APPROVED 3/22/90
EXPIRATION DATE 3/22/90
DATE ISSUED
i 3/22,00
B-
yi
Administrative Authority
TELEPHONE: (619) 564-U46
V