05494
NOTE:
W•th 1•Id
+ i proper va a lon
this -form constitutes an
encroachment permit •t CITY OF LA QUINTA Al
APPLICATION' FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) Ike:. sww�
ONE TRIP OVERSIZE. PERMIT ' : OF
For the construction of public or private curbs, driveways, pavements, sidewalks, parkinglots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
+ f Subdivision Improvement Permit —Class III
�.
' DATE:.. i
Minor Improvement Permit Class IV 2
. LOCATION 10 tF CONSTRUCTION �`� y •� - +r �x,
+ ' i
f L
ti
(Street address or Description of
{ , ,
PURPOSEOF CONSTRUCTION -Sketch (attach construction?plans if appropriate) '
DESCRIPTION OF CONSTRUCTION HAUL ROUTE:' 'W1'TOI TO
mn�sRa car.,,nmcrv+i• (`a i- rr�ay�rc� 1 a�w^ral 3 1 n•� til+ wi f�A. ErSENHOWER TO 'Cgitii GULTMA:
l{ DIMENSION, OF INSTALLATION OR REMOVALo.
y' ' 7;` j. ,' '� ly-�• i
SIZE OF EXCAVATION; IF NEEDED
.'`'3/ 29 /9.0 �_f
APPROXIMATE TIME WHEN,WORK WILL BEGIN$ t t s,,l�- ;+
,t APPROXIMATE TIME OF COMPLETION:'`
'ESTIMATED CONSTRUCTION COST $ �' � � v''� _,��• "� t ar-j ��`� r#�� r'.yjY`� �
(Including removal ofall obstruction, materials and debris, b ck#ill g; com="'� r _ f+ i', "•'#""`' `'
paction and placing petmanent'resurfacing.'and/or replacing improL rents)
In consideration of the granting of this permit, the applicant- hereby agrees to:,� I 4
iw41
Indemnify, defend.afid save the City, its authorized agents, officers, 'representatives and employees, harmless.froaand vagainstlany and alit°»
penalties; liabilities or loss resulting from claims or court action and arising out of any accident, loss o, damage to persons,or,property, y.
'happening oroccurringas approximate result of any work undertaken under the permit granted pursuant=to this appllcatlon:� t Xf"
`� Vii" C
Notify the`Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.ts, I r ` `
NS
Comply with alLapplicable City Ordinances: the terms and conditions of the permit and'all.applicable rules and regulatidm of.,the Cityjof
°,', , } • La Quinta'and to pay for any additional replacement necessary as the result of this work:"' + '$s4 _�.,. �+ %%
r.Y Signature of Arplicant or Agent �.`* -; "44^
/ + ,
Massey Sand and Rock Co. PO Box 1767 Indio CA 92201;''
Name of Applicant (please print) Business Address s "' F TeleplioneNo: `'''
Name of Contractor and Job Foreman Business Address +7': Telephone,No�=a' '
on file '' , ,;'4 `on. file'..
1.Contractor,s License No. City Business License•No
_ton file
' Applicant's Insurance Company Policy;Number sw• r i ` �,
,, FEES:.•. Subdivision Improvement`Permit — Class III
,.
Public improvements: 3% of estimated construction costs 4 +;
{Private improvements: 3% of estimated construction costs
f 821 43-� �.0 • t G
+. Mirior, Improvement Permit —Class IV: See attached schedule ` (• r L :;�">� J0.00
.. r .
Inspection Fee $ " r PERMIT VALIDATION ,
Permit Fee 10.00 ; PERMIT NO. <
'S 0549
Penalty 1,-i . 3/28/90 r
Cash Deposit -Surety Bond ,
DATErAPPROV ED
if required EXPIRATION DATE 3/29/90. 10.00
TOTAL: $ DATE ISUED.. 3/28/90
Receipt No.
+ By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
14,
_ .
NOTE: t
With proper validation
this form constitutes an
encroachment permit rr CITY OF LA QUINTA
APPLICATION
tFOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
c�Sw4ti
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 -
• Subdivision Improvement Permit — Class II I y
DATE:/2R /9f1 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION t,
(Street address or Description of Location)
PURPOSUF CONSTRUCTION' Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION HAUL ROUTE: WASHINGTON TO
MnITA nrn• i nmoon t rA t nA\7Pr 1 A a a 1 ; 1. n,, H " cai do 'EISENHOWER TO CALLE COLIMA,
DIMENSION OF INSTALLATION OR REMOVAL -^— _15
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN`,3�29j$'O,
/
APPROXIMATE TIME OF COMPLETION,--
ESTIMATED CONSTRUCTION COST $f 1)
(Including removal of all obstruction, materials, arid debris, ba k'filling, com-,
paction and placing permanent resurfacing and/or replaying improvements)` _
In consideration of the granting of this permit, the apphdantRhereby 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 AVplicant or Agent '
Massey Sand and Rock Co. PO Box -1767 Indio, Ce92201
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 III
All
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 03-28-90
4 I � t.�iS.q l"il I 0
AL 1 S O.Ut} 0
Minor Improvement Permit — Class IV: See attached schedule z
Inspection Fee $ PERMIT VALIDATION ~
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required.
10.00
TOTAL: $
Receipt No.
Received by Date
Recorded by
I
PERMIT NO. 0549
DATE APPROVED 3/28/90
EXPIRATION DATE 3/29/90
DATE ISSUED 3/28/90
By—
Administrative Authority
TELEPHONE: (619) 564-2246
P
NOTE:
With proper validation
this form constitutes'an CITY OF LA O.UINTA
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
4.
�j 7 Subdivision Improvement Permit — Class III
DATE: O 7 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
�� l0
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
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damede 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 Applicant or AAnt
Name of Applicant (please inti Business Address Telephone No.
Name of Contractor and .fob Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy -Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs .
Private improvements: 3% of estimated. construction costs' +TO
Minor Improvement Permit - Class IV: See attached schedule
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 II TELEPHONE: (619) 564-2246