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NOTE:
With proper validation
this form constitutes an
encroachment permit
� 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 MINOWIMPROVEMENTS and APPROVED SUBDIVISIONS
April 30, 1990 y' Subdivision Improvement Permit — Class III
DATE: 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)
r
DESCRIPTIwitie, .. N OF height I an w ,. - oagx �, rr HAUL ROUTE: WASHINGTON SOUTH
TO AVE -.52 WEST, TO +BERMUDAS SOUTH
DIMENSION OF INSTALLATION OR REMOVAL TO EISENHOWER
SIZE OF EXCAVATION, IF NEEDED MVUE .ON May l,. 1990 or May 2, 1
1990 (ONE, DAY, ONLY)
APPROXIMATETIMEWHEN WORK WILL BEGIN
'APPROXIMATE: TIME OF.COMPLETION i0 5.1 CF��H i�74QTA14 � 0,•90 1.U.0414
ESTIMATED CONSTRUCTION COST $
,'—(Including removal of all obstruction, materials, and debris, backfilling; com-
paction and placing permanent resurfackg 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 fromand against any and all
penalties, liabilities or loss resulting from claims or court action and wising 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 Ouinta and to pay .for any additional replacement necessary as the result of this work.
maospaaa SPP4 end Rack rd- PQ RAx 3.767 Tniij-6. CA 92201
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.
on file
City Business License No.
�;
U3
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 z
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
10.0 0
TOTAL: ' $ 10.00
Receipt No.
Received by Date
NY os�n
PERMIT VALIDATION
PERMIT N0. 0610
DATE APPROVED 4/30190
EXPIRATION DATE 5/2/90
DATE ISSUED- 5/30/90
ByAkA�Q==. Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
5
+M:+i•+e4Ki•".��'►+4w.b?-fi�-�.^w�.•Y. ..� .r .Y. e► .;.. 0u�. n..+. -M- r r yw .Yrr ar. rr.�i: a. r .a .x r .a. wi..d: K. � (... w�. w�'r!. -r-wr'.`. K+.ir .r.� a►. w n.r� .r..:.+r-w. ..
NOTE: _N
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
.April 30, 1990 • Subdivision Improvement Permit — Class III
DATE: 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 CONNSTRUCTION 11 11
wide, height an wel oeg HAUL ROUTE: WASHINGTON SOUTH
TO AVE.52 WEST TO BERMUDAS SOUTH
DIMENSION OF INSTALLATION OR REMOVAL TO EISENHOWER
4
SIZE OF EXCAVATION, IF NEEDED MUUE ON May 1, 1990 or May 2, 1
1990 (ONE DAY ONLY)
APPROXIMATE T,IME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 005i�" !� i� 3$4 04-30-•90 14
ESTIMATED CONSTRUCTION COST $ 10 A§8 YTAL 1 1 U:00
(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:
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 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.
MmcQ,zv Rand and Rack Co. PO' BOX 1767 Indio, CA .9220.1
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.
nn f i l a
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of estimated construction costs '''
s,
Private improvements: 3% of estimated construction costs
0.6.0
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
e
Received by Date
1.
Recorded by
PERMIT VALIDATION
PERMIT NO. 0610
DATE APPROVED 4/30/90
EXPIRATION DATE 5/2/90
DATE ISSUED- ./ 5/30/90
By
Administrative Authority
TELEPHONE: (619) 564-2246