0559• F
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
Subdivision Improvement Permit — Class III
DATE: �-�_�� i ? o= Minor Improvement Permit Class IV
""LOCATION OF CONSTRUCTION MOVE EQUIPMENT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION maitar 10 r ti" wi c3p
lea al hpitTSt an(i wt+icrht
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HAUL ROUTE: WASHINGTON AT FRED
WARING•TO AVENUE 52 to BERMUDAS
TO EISENHOWER DRIVE.
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including ',removal. of all obstruction, materials, and debris, backfilling, corn-
�� 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(of)Applicant or Agent
Massey. Sand and Rock Co PO Box 1767 Indio/CA 92202
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. r'
x
on file
City Business License No.
on file '
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
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee _
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: .
Receipt No.
10.00
$ 10.00
Received by Date
i 0 i$�:�ASH i. ('3T AL 07-v0 i0.00 0
N2 0559
PERMIT VALIDATION
PERMIT NO.
nr%
DATE APPROVED
4/5/90
EXPIRATION DATE
4/6/90
DATEISStAD• ,
4/5/90
B" V V
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246 '
is '
NOTE:
With proper validation,
this form constitutes an
encroachment permit
.i. .ir""mow-u►,..r ._. _ .__ __ __._. ._.. .. _ .. _ �- .,...._ _ _.- _ — .-
CITY OF LA QUINTA
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
Subdivision Improvement Permit — Class III
DATE: Apgll M, loan Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE EQUIPMENT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION navp'x 1016" wide
1 Aaal, hp aht anci wod,aht
DESCRIPTION OF CONSTRUCTION
DIMENSION .OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HAUL ROUTE: WASHINGTON AT FRED
WARING/TO AVENUE 52 to BERMUDAS
11
TO EISENHOWER DRIVE '
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 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(oJApplicant or Agent
Massey Sand and Rock Co. PO Box 1767 Indio/CA 92202
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
h
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs 0051020 325 �4-�U5-''?G U
Private improvements: 3% of estimated construction costs 310 &I �Tb �AL 1 i0.O
n_
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10.00
$ 10.00
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 6559
DATE APPROVED 4/5/90
FXPIRATIr)N nATF 4/6/90
DATE ISSUED- • 4/5/90
By✓1
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper validation # 4 this form constitutes an, CITY.-OF LA O,UINTA
encroachment permit ' .. - -
APPLICATION FOR 'PERMIT
y
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 conn-ection with'MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
Subdivision Improvement Permit = Class III _,_.`
DATE: / Minor Improvement Permit Class-IV
-LOCATION OF CONSTRUCTION _r
(Street address or Description of Location) y
PURPOSE OF CONSTRUCTION.Sketch (attach construction plans if appropriate)
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 ally'obstr'uction, materials, and debris, .backfill:ng, corn
paction and placing permanent, resurfacing and/or.replacing. improvements) • Y
In Iconsideration of the, granting of•this permit; _th"e, 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 pei�ions or,propertyi .
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 46licant or Agen
l Name of Applicant (ease print) 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 T ` `` Policy Number f, .
ti.
FEES: Subdivision Improvement Permit —Class I II P_ Y
Public improvements: 3%sof estimated construction costs :c
Private improvements: 3% of estimated construction costs NO
Minor Improvement Permit —Class IV: See attached chedule ' l,I
y. Inspection. Fee $ k ' t. PERMIT VALIDATION
Permit. Fee
PERMIT NO:
Penalty
Cash Deposit Surety Bond
,.DATE APPROVED
if requiredEXPIRATION'DATE
TOTAL: $ DATE ISSUED "
Receipt No. '
By
Received by Date Administrative Authority
Recorded by +^ TELEPHONE: (619) 5642246