0572NOTE: • r _� �, y
ii
With: prooer.validation '' Q
this form constitutes an
s• encroachment permit
{ CITY OF LA .QUINTA
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 MINOWIMPROVEMENTS and APPROVED SUBDIVISIONS
+ Subdivision Improvement Permit — Class III
DATE`. Anx it 11. 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE EQUIPMENT '.
(Street address or.Description of Location)
PURPOSE OF CONSTRUCTION y Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION,- A**XlR;kftJii0A,,%8R HAUL ROUTE: BERMUDAS TO 52nd
i at navPr. - l n " 11 W .:•wP.i aht. and hoi aht legal AVENUE to JEFFERSON
DIMENSION OF INSTALLATION OR REMOVAL
MOVE ON:'.I ' April' 11, . 19,9 0
SIZE OF. EXCAVATION, IF NEEDED w
APPROXIMATE TIME WHEN.WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 4/11/90 �+� 105i8AQ 14 QTF�L-1 i~90 50.0014
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, y
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 Ou.inta 'and to pay for any additionalreplacementnecessary as the result of this work. '.
i
Signature o1`Applicant or Agent' ' l MASSEY ,SAND' AND ROCK �CO. P.O. Box 1767, Iindio CA; , 92202
Name'of Applicant (please print) Business. Address • r Telephone No.=
Name of Contractor and Job Foreman : Business Address Telephone No.
On fele .. .
On f iie
Contractor's License No. City Business License No. a, x
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 scheduler'. 0572.
Inspection Fee $
+ PERMIT VALIDATION
Permit Fee 1000 F
E PERMIT NO. 0572
Penalty. .. 4/11/90
Cash Deposit -Surety. Bond DATE APPROVED
if required EXPIRATION DATE 4/11/90
TOTAL: $
Receipt No.
Received by Date
Recorded by
DATE ISSUED 4/11/90'
9*1-ry D�Coff6f Administrative Authority
TELEPHONE: (619) 564=2246
NOTE:
,e With proper validation
r` this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS, CONSTRUCT.ION (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 .
DATE: Aiori'1. 11. 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE EQUIPMENT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION.OF CONSTRUCTION' 98IRMIRARXR18►9tMER
aat 'nAver, 1016" W. waiaht and hef.aht leaa1
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
HALL ROUTES BERMUDAS TO 52nd
AVENUE to JEFFERSON
MOVE ON:., April `ll, 1990
APPROXIMATE • TIME WHEN WORK WILL BEGIN 4/11/90
APPROXIMATE TIME OF COMPLETION 4/11/90 Q83182Fi10 J412 g4-��1-5+0 �Q.f0014
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 alll 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. P.O. 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
FEES: "Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs �T7
Minor Improvement Permit — Class IV: See attached schedule N2
Inspection Fee $ II PERMIT VALIDATION
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required ,
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT NO. 0572
DATE APPROVED 4/11/90
EXPIRATION DATE 4/11/90
DATE. -ISSUED ,4/11/90By
/
Jerry D./ Coffdy A'nistrative Authority
L__ w dmi
TELEPHONE: (619) 564-2246
With proper validation .
this form constitutes an 1 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
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 ,
Vo
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 0 obstruction, materials, and debris, backfilling, co
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 (241 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 pIicant or A nt
Name of Applicant( ase 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 A Policy Number.
FEES: Subdivision Improvement Permit —Class III
•. VI1VGlC 11,,w1VVCIIICI'La. J/V VI GJ L1111a1CV V 11Jl1 VVLI VII YVJ�:
Minor Improvement.Permit — Class IV: See attached schedul
Inspection Fee $ `
Permit Fee
Penalty
Cash Deposit -Surety Bond,
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
J• • O
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
.EXPIRATION DATE
DATE ISSUED
Administrative Authority'
TELEPHONE: (619) 564-2246