0555.. .. ..._,.._ - �_�. .....ter.-..,..�..�,......=.:..F. .. ---_. _. ...._ .- - -- .._..
• s
NOTE:'
With proper validation
this form constitutes an CITY OF , LA QUINTA
encroachment permit
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,
4/3/90 Subdivision,lmprovement Permit - Class III
DATE: Minor. Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVII' EQUIPMENT ,
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION metre Rarher Grpenp Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 1016" taide mei ght/
wi fmcirht legal HAUL ROUTE: AVENUE 52 to
BERMUDAS TO EISENHOWER
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
g 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:
t '
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.,
e
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. �S
Signature ofdpplica t r Agent"
M»ssey Sand and Rock PO -Box 1`767 Indio, CA 92202
Name of Applicant (please print) Business Address Telephone No:
Name of Contractor and Job Foreman Business Address Telephone No. ,
on,filo 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
f
Public improvements: 3% of estimated construction costs 00518 4-03-90 i0
Private improvements: 3% of estimated construction costs �wlh
i io .00
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10.,00
$ 11; 00 ;
Received by I Date
PERMIT VALIDATION
PERMIT NO. DSc; c;
PATE APPROVED 4/3/90
EXPIRATION DATE 4/3/90
DATE ISSUED- Q 'A / Q n
By
Administrative Authority
Recorded by II TELEPHONE: (619) 564-2246
4.
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
A
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
DATE:
4/3/90
Subdivision Improvement Permit —Class I II
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE EQUIPMENT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION move Barber Greene
DESCRIPTION OF CONSTRUCTION 1016" wide s—height/
wieaht leaal
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HAUL ROUTE: AVENUE 52 to
BERMUDAS TO EISENHOWER
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including iemoval 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 ofFApplican`t or Agent
MUsseY Sand and Rock PO Box 1767 Indio, CA 92.202
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
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:
10.00
Receipt No.
Received by Date
Recorded by
r, Q5T�L� 11.03!.0.Oni0
I
I
PERMIT VALIDATION y
'PERMIT NO. 0555
DATE APPROVED 4/3/90
'EXPIRATION DATE 4/3/90
y DATE ISSUED- i 4/3/90
By
Administrative Authority
TELEPHONE: (619) 564-2246