0579NOTE:: r
With proper validation
' this form constitutes an
encroachment permit
R
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
DATE: ,April 12, 1990
LOCATION OF CONSTRUCTION _ OVERSIZE LOAD
(Street address or Description of Location)
PURPOSE OF. CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
1
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
HAUL ROUTE: South on WASHINGTON
to AVENUE 48'
DIMENSION OF INSTALLATION OR REMOVAL ^_11 T Ml
�+- r MOVE ON: April 12, 1990
.G'rad"er, 3 -axle. tractor, 2 -axle trai er
'9' v,112,3U# G.W.
SIZE OF EXCAVATION,.I!F NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN April 12, 1990
7:00 p.m. - 8:00 p.m.
APPROXIMATE TIME OF COMPLETION April 12, 1290.
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 of Applicant or Agent
CAL PERMITS INC. P.O. Box 799, San Bernardino, CA (800) 344-1911
i "Name of Applicant (please print) Business Address Telephone No.
'SCHWAB SALES ' 195 E. Warner Rd., Chandler,,AZ 85225
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Farmers Insurance Group 600221517
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class ll l
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
10.0
TOTAL' $
Receipt No.
Received by Date
Recorded by
to
to- FASi-10 i TOTAl.4-i2-9Q i o .06
N° 0579
PERMIT VALIDATION
0579,
PERMITNO.
DATE APPROVED 4/12/90
EXPIRATION DATE A.1I I”cQn
DATE
)I�SSUED / 4/12/90
Byre ` �
erry Dd fey/dAdministrative Authority
TELEPHONE: (619) 564-2246
r
r NOTE:
With proper validation
this form constitutes an
CITY OF LA QUINTA
encroachment permit
Y APPLICATION FOR PERMIT
PUBLIC .WORKS CONSTRUCTION (ENCROACHMENT)
t•
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
April 12, 1990 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION — OVERSIZE LOAD
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
HAUL ROUTE: South on WASHINGTON,
to AVENUE 48
MOVE 014:
April 12, 1990
-9' w, 112,3x3# G.W.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN April 12, 1990
7:00 p.m. - 8:00 p.m.
APPROXIMATE TIME OF COMPLETION April 12, 1190
,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.
f
Comply with all applicableCity 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
CAL PERMITS INC. P.O. Box 799, :San Bernardino, CA (800) 344 -1911 -
Name of Applicant (please print) Business Address Telephone No.
SCHWAB SALES 195 E. Warner Rd., Chandler, AZ 85225
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Farmers Insurance Group 600221517
Applicant's Insurance Company Policy Number
FEES: Subdivision] mprovement Permit — Class I II 05i8 0 — 2 -11 10
Public improvements: 3%of estimated construction costs iI r � �''�
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.
Received by Date
Recorded by
PERMIT VALIDATION
0579
PERMIT NO
DATE APPROVED 4/12/90
EXPIRATION DATE 4/12/90
4/12/90
DATE
ISSUED
(I''Jerry D. t'CoTtey/ g-dministrative Authority
V
TELEPHONE: (619) 564-2246