0606t
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
andother like, public works improvements in, connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
0
Subdivision Improvement Permit — Class I I I
DATE: April 27 ; 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE EQUIPMENT
(Street address or Description of Location) Y
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate),
DESCRIPTION OF,CONSTRUCTION' rai- A11 HAUL ROUTE: ,..50th and Washington.
1512H. 13!6'!w, 90L toHighway,lll
DIMENSION OF INSTALLATION OR REMOVAL Pilot cars will be required . (2) '•
HAUL DATE: May' 2, 1990
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
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.
Sign to of Applicant'or Agent '
.qnhuT;4h Sa1ac. 17 1; F._ .Warnar 'Rd. f Chandler, AZ
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.
onfi e
Applicant's Insurance Company, Policy'Number
FEES: ' Subdivision Improvement Permit — Class III �p},QS3 3Q0QQ 10
Public improvements: 3% of estimated construction costs i Q .�� i' , r OTe12 I io (70
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class-`I.V: See attached schedule 06
06
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. 0606
DATE APPROVED 4/27/90
EXPIRATION DATE--,- 5/3/90
DATE ISSUED^/`l# :4t27/90
By—� .Administrative Authority`
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)
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 I I
DATE: April 27, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE . EQUIPMENT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION rat 613 scraner
15'2H, 13'6"w, 90L
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 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
Sketch (attach construction plans if appropriate)
HAUL ROUTE: 50th and Washington
to Highway Ill
Pilot cars will be required (2) 1
HAUL DATE: May 3, 1990
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. �\
Signa`t"uur of Applicant or Agent
_hwah c;a l ps, 175 E. Warner Rd_.. Chandler. AZ
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
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
i °51i,�'?,3200 04i27-9°sn 00%o.
No 0606
PERMIT VALIDATION
PERMIT NO. 0606
DATE APPROVED 4/27/90
EXPIRATION DATE 5/3/90
IDATE'ISSUED— 4/27/90
ByI
Administrative Authority
TELEPHONE: (619) 564-2246