0540NOTE:
With proper validation
this form•constitutes an
encroachment permit
CITY OF LA QUINTA `
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE 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
March 22; 1990
Subdivision Improvement Permit— Class �II I
DATE: t Minor Improvement Permit Class IV.
LOCATION OF CONSTRUCTION MOMP EQUIPMENT
(Street address or Description;of Location_) + ti
PURPOSE OF CONSTRUCTION �� r « Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION motor grader HAUL ROUTE: Hwy Ill to
Washington; South to Avenue 52
' east din Avenue 52 1/4 mile
DIMENSION'OF INSTALLATION OR REMOVAL 4
_ . ,ti10' 117 -Vide, legal length, height, -weight . '
-SIZE OF EXCAVATION,'IF NEEDED .,
'APPROXIMATE TIME WHEN WORK WILL BEGIN i 2 2 /9� R
APPROXIMATE TIME OF COMPLETION 1 /Qn ms's✓
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction
om 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 Quinti and to pay for any additional replacement necessary as the result of this work. �.
*
Sign`ature of Applicant or Agent
S,�+Tomh 0A AA on Dcarmi t 1 AC V t4a10e9 rhanAl0mv-, A7.
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
{ �000 CASH 1 TOTAL i 2~g0 910 i4
i0.00
Contractor's License No. City'Business License No: t
Applicant'sInsurance Company Policy Number ,
FEES: • Subdivision Improvement Permit _ Class I II +
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
o
Minor Improvement Permit —Class IV: See attached schedule -0540 ,
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$ 10.00
Receipt No.
Received by Date
PERMIT VALIDATION.
PERMIT NO. 0540
DATEAPPROVED 3/22/90
EXPIRATION DATE 3/22/90
DATE ISSUED i 3/22/90
By
Administrative Authority
Recorded by II TELEPHONE: (619) 564-2246
u
NOTE: ;
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION: FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE'TRIP OVERSIZE 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
March 22, 1990 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE EOTJIPMENT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION motor grader HAUL ROUTE: Hwy 111 to
Washington, South to Avenue 52
east bn'Avenue 52 1/4 mile
DIMENSION OF INSTALLATION OR REMOVAL
:10' 11" wide, legal length, height,. weight
SIZE OF'EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3 /o2 pop
APPROXIMATE TIME.OF COMPLETION 3.42,400
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 twpersons 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., I r
A.
Signature of Applicant or Agent "
Schwab salaa, ('_ail Permit 195 R_ Jnlarnwr, Rd. Chandler, .AR
Name of Applicant (please print) Business Address- Telephone No.
Name of Contractor and Job Foreman Business Address g �p Telephone No.
3 0051 CSS"H i AL3 22-9010.00 14
Contractor's License No. City Business License No.
an - fiilp
Applicant's Insurance Company Policy Number
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 -
S 0540
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
'if required 1: 4 - ,
TOTAL:
Receipt No.
10.00
$ 10.00'
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 0540
DATE APPROVED 3/22/90
EXPIRATION DATE 3/22/90
3/22/90
DATE, ISSUED s
By—
Administrative Authority
TELEPHONE: (619) 564-2246 ,