0548zS`
NOTE: 4*
With proper validation
this form constitutes an
ericroachment permit CITY OF LA QUINTA `
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OVERSIZE ONE TRIP PERMIT'
r ,
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
3/2$/90 Subdivision Improvement Permit—Class III
DATE: 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
Barber Green 265 1Pcra 1 h u,� rj-Aclri- 3 n. r, it Wide
DIMENSION OF INSTALLATION OR REMOVAL HAUL ROUTE:
WASHINGTON TO
SIZE OF EXCAVATION, IF NEEDED COLIMA
EISENHOWER TO CALLS
APPROXIMATE TIME WHEN.WORK WILL BEGIN 3 ?_2190
APPROXIMATE TIME OF COMPLETION 3 /29 /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.
x
Comply, with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules.and regulations of the City of
La 6uinta and to pay for any additional preplacement necessary as the re ult of this work. t
j1 1
Signature of A<plicant or Ag'Pt "
Massey Sand and Rock Co PO Box 1767 Indio_, CA 92201. `
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman . Business Address 'Telephone No. '
on .file
Contractor's License No.
on ff1p
City Business License No.
on f ile
Applicant's Insurance Company Policy Number
FEES: ,Subdivision Improvement Permit — Class II I
J Public improvements: 3% of estimated construction costs
' "Private improvements: 3% of estimated construction costs 5i8 d ' 3038 , 0 —n--90 10
Minor Improvement Permit — Class IV: See attached schedule
4 CR3 10.
ra3 00
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 0548
DATE APPROVED 3/29/90
EXPIRATION DATE 3/29/90
DATE ISSUE 3/28/90
By—
"'Administrative Authority
TELEPHONE: (619) 564-2246
.. .......
yt
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OVERSIZE ONE TRIP 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
3/28/90 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class,IV
LOCATION OF CONSTRUCTION r
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Sketch(attach construction plans if appropriate)
.r
DESCRIPTION OF CONSTRUCTION
Barber Green 265 legal h wipaht; 11n l Wide
DIMENSION OF INSTALLATION OR REMOVAL HAUL ROUTE:
WASHINGTON TO EISENHOWER TO CALLE
SIZE OF EXCAVATION, IF NEEDED COLTMA
'APPROXIMATE TIME WHEN WORK WILL BEGIN 3/29/90
APPROXIMATE TIME OF COMPLETION 3/29/90
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. 'f
'Signature of Applicant or Agent
Massey Sand and Rock Co PO Box 1767 Indio, CA 92201
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
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs
it 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 i
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
8_90 io.000
PERMIT VALIDATION
PERMIT NO. 0548
DATE APPROVED 3/29/90
EXPIRATION DATE 3/29/90
DATE ISSUED 3128/90
By
/Administrative Authority
TELEPHONE: (619) 564-2246
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
3 _
Subdivision Improvement Permit — Class III
DATE:
Minor Improvement Permit Class IV
LOCATION OF.CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Sketch (attach construction plans if appropriate)
jrS—
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
--
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstru ion, materials, an6 dei ell, uac:icfilling; 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 Quints and to pay for any additional replacement necessary as the result of this.,work.
Signature of AppliediAt or Agent
IT
Name of Applicant (please pf(nt) Business Address Telephone No.
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 I I I
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 $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE'
DATE ISSUED
By
Administrative Authority
Recorded by TELEPHONE: f6191564-2246