0552NOTE:
With proper validation
this form constitutes an
encroachment permit
a
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE PERMIT
For the construction of public or pirivate curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
•
4/2/90
Subdivision) mprovement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE EQUIPMENT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
j
DESCRIPTION OF CONSTRUCTION 2�5 13arh�r C,rxar�n
1D'911 widAr 1ada1 hAir�rh1-�ta�bicrht
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HAUL ROUTE:
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:
Eisenhower and Colima to Bermudas
to Avenue 52 to Jefferson
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 Ouinta and to pay for any additional replacement necessary as the result of/this work..
` Signature of°Applicant or Agent ,
Massev Sand and Rock Co PO Box 1767 Indio. CA 92201
Name of Applicant (please print) Business Address .'N . Telephone No.
�r
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No. �.
on f ile.
z,
Applicant's Insurance Company Policy Number
VVJ3i3 ' }•� a r vw—yc �v
FEES: Subdivision Improvement Permit — Class I I I iU eAJH 1'TAL 1 10.00 i0
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs ® O 2
Minor Improvement Permit — Class IV: See attached scheduleR
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 111 - (In
Receipt No.
Received by
Date
PERMIT VALIDATION
PERMIT NO. 0552
DATE APPROVED 4/2/90
EXPIRATION DATE 4/2/90
DATE ISSUED A/2AD
By
Administrative Authority .
Recorded by II TELEPHONE: (619) 564-2246
0
Lx T'b �r rtw iw W
r.
NOTE:
With proper validation
this form constitutes an
encroachment per
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
Subdivision Improvement Permit — Class II I
DATE: 4�2�90 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE EQUIPMENT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION 265 BerhPr rrP_Pn
10' 6" wide, leaal hP_j aht /w&. t aht
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
HAUL ROUTE:
Eisenhower and Colima to Bermudas l
to Avenue 52 to Jefferson
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME -WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
4
(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 offApplicant or Agent
Massey Sand and Rock Co PC, Box 1.767 Indio, CA 52201
Name of Applicant (please.print) Business Address Telephone No.,
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class II I
i0 alu 1 A`'TA � i ` ;"0:00 ib
Public improvements: 3% of estimated construction costs
Private improvements: 3% of'estimated construction costs
�,p 05 e� "
Minor Improvement Permit — Class IV: See attached schedule �d,�Vj G
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
10.00
TOTAL: $ 10,.00
Receipt No.
Received by Date
PERMIT VALIDATION
PERMIT NO. 0552
DATE APPROVED 4/2/90
EXPIRATION DATE 4/2/90
DATE ISSUED" 4/2/90
Administrative Authority
Recorded by II TELEPHONE: (619) 564-2246
�`
,
1
a
NOTE:
With proper validation, -
this form constitutes an 'CITY OF LA .QUINTA
encroachment permit
APPLICATION' FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
.. Og Tk1�9
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 II1
DATE: Minor Improvement Permit Class'IV
LOCATION OF CONSTRUCTION
(Street address or Description of,Location)
PURPOSE OF CONSTRUCTION Sketch Wtach construction• plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
Y►�Q= to (,?-d•-� - s"�- �v
SIZE OF EXCAVATION, IF NEEDED'
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 'arid>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 ."en 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 Agen
Name of Applicant ease print) Business Address" Telephone No.
Name of Contractor and Jobe Foreman Business Address.. '' : -Telephone No.
Contractor's License No.,' CityiBusiness License No.
Applicant's.lnsurance Company Policy Number
FEES: Subdivision Improvement Permit.— Class I II
Public improvements: 3% -of estimated construction costs '
Private improvements:. 3%16f estimated construction costs
N°
Minor Improvement Permit — Class IV: See attached schedule'
Inspection Fee $ PERMIT 1VALIDATION
Permit Fee PERMITN0.1
Penalty DATE'APPROVED
Cash Deposit -Surety Bond
if r6quired EXPIRATION DATE
TOTAL: $ DATE ISSUED
Receipt No.
By
Received by,, Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246'
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA O.UINTA
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'
Subdivision Improvement Permit'— Class II I --------
Minor '3 �� 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
I le
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 -obstruction; mizzi ia, . aria i6bris, 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 Quints and to pay for any additional replacement necessary as the. result of this work.
Signature of A plicant or A nt
n
Name of/Applicant ease print) Business Address Telephone No.
Name of Contractor and Job.Foreman Business Address Telephone No.
a x.
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: 395 of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule N�
Inspection Fee $ PFRMIT'VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246•