0573,R.
NOTE:
With proper validation .
this form constitutes an
.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 MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit = Class III
DATE: Anril 12. 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION — M01IR 1R0i1TPMrWT
(Street address or Description of Location) `
PURPOSE OF CONSTRUCTION ) , Sketch,(attach construction plans if.appropriate)
DESCRIPTION OF CONSTRUCTION='omgeo cj__-h ma-bina ,
016i, To - hPi Crht-/wA, erht- ]_aaRl HAUL -ROUTE_ : WASHINGTON AT..
TAMPICO - NORTH.TO CITY LIMITS
DIMENSION OF INSTALLATION OR REMOVAL
ti
*MOVE 'ON: April. 12/13, 19:90
SIZE OF EXCAVATION, -IF NEEDED
APPROXIMATE TIME WHEN,.WORK WILL BEGIN 4/12/90
~ APPROXIMATE.TIMEDF COMPLETION 4/13/90 _
ESTIMATED CONSTRUCTION COST $
(Includirig removal of all obstruction, materials, and debris, backfilling, com-
paction' and placing
ompaction'andplacing permanent resurfacing and/or replacing,irriprovements)
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, losss"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
l:a Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant orAjent
MASSEY• SAND• AND ROCK ,CO,, P.O, BOX 1767, Indo, 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 'On file`
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
a .
j Public improvements: 3% of estimated construction costs r . 2 Q4-12-90 iQ
Private improvements: 3% of estimated construction costs. • TO' TAL i 10.00•
.057-3
Minor Improvement Permit — Class IV: See attached schedule.
ti
`•"Inspecti6rTFg'e " - $ PERMIT VALIDATION.
Permit Fee I n • nn PERMIT NO. 0573
•--
�P.enalty '
DATE
Cash Deposit -Surety Bond APPROVED - G X12 /90
if required EXPIRATION DATE 4/13/90
TOTAL: $ 10.00 r_ 4/12/90
,-' DATE ISSUED •
'Receipt No.
By
Received by Date Jerry D. Coffey/C.Administrative Authority
Recorded by TELEPHONE: (619) 564-2246 .
NOTE: `.
With proper validation
this form constitutes an
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 MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class I I I
DATE: ,April 12. 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MON1F FOIJIPMFNT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) ,
DESCRIPTION OF CONSTRUCTION Cnmann r��r1ma�hi inc
Q 1 w~rr ra - height/uaeiaht leaal HAUL ROUTE: WASHINGTON AT
TAMPICO - NORTH TO CITY. LIMITS
DIMENSION OF INSTALLATION OR REMOVAL
MOVE ON: April 12/13, 1990
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 4/12/90
APPROXIMATE TIME OF COMPLETION 4/13/90 ;
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:
Intlemnify,•defend and save the City, its authorized agents, officers, representatives arid employees, harmless from and againstany 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 ROCR�CO. -P.O. Hox 1767, .Indo, 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. i City Business. License No.
On file l On f ile
Applicant's Insurance Company Policy Number_
FEES: Subdivision Improvement Permit— Class I I I
Public improvements: 3%of estimated construction costs
Private improvements: 3%gof estimated construction costs
Minor Improvement Permit J,Class IV: See attached schedule
Inspection Fee $
4
Permit Fee n no
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date 1
0854 Gr'�SH i $ fJ'i'AL AT O :�0, 00iO .
° 0573
PERMIT VALIDATION
PERMIT NO.
0573
DATE APPROVED 4/12/90
EXPIRATION DATE 4/13/90
DATE ISSUED _ 4/12/90
By .
Jerry D. Coffey/r Administrative Authority
Recorded by II TELEPHONE: (619) 564-2246
1
y ..:: .... __ _.0 low
•. _ _
V
NOTE:.
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
z
..APPLICATION FOR . PERMIT '
RPUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
r
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 ill
DATE:
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Sketch-lattach construction -plans -if -appropriate)
C"
DESCRIPTION OF CONSTRUCTION
DIMENSION OFINSTALLATION OR REMOVAL
OF EXCAVATION, IF NEEDED
SIZE
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION; COST $ d
(Including removal of all obstruction, materials, and debris, backfilling, C rr-
• paction and placing permanent resurfacing and/or replacing improvemen
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 necessaryas the .result of this work.
Signature pplicant or Ayft
!ami/G���. • �c� �/� �. . '
Name of ApplicantOplease 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 Policy Number
FEES: Subdivision Improvement Permit = Class
Public• improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs . AT
Minor Improvement Permit— Class IV: See attached schedule. lr
Inspection Fee $ .PERMIT VALIDATION
Permit Fee; PERMIT NO'.
Penalty DATE APPROVED
Cash Deposit -Surety. Bond
if required EXPIRATION DATE
,TOTAL: $
.Receipt No.:
Received by + Date
Recorded by
DATE ISSUED
By y
Administrative Authority
TELEPHONE: (619) 564-2246