0629' NOTE:
With proper validation
this form constitutes an
encroachment permit
.,f
,y
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
May .7, 1990 SubdivisionlmprovementPermit Class 111
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 CONSTRUCTION Cat 633 scraper HAUL ROUTE: WASHINGTON AND Ave.
5.2 to Washington and .Hwy 111 -and
return
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF'.EXCAVATION; IF NEEDED HAUL DATE: May 7, 1990
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. Authohty 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
KAmm; a T.avy+ik A D(1 pr x A77 TcmAetii1 a (`A 'cmgn
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. City Business License No.
on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of e" timated construction costs -
Private improvements: 3°/a of estimated construction costs%S� 0629
Minor Improvement Permit — Class IV:,See attached schedule+ ,
Inspection Fee $
10-.00
Permit.Fee
Penalty
Cash Deposit -Surety Bond
if required,
TOTAL: $ i n . n n
Receipt No.
Received by
Recorded by
Date
PERMIT .VALIDATION
PERMIT NO. 0629
,
DATE APPROVED 5/7/90
5/7/90
EXPIRATION DATE
DATE ISSU;E�D,�5/7/90
;
By—
Administrative Authority
TELEPHONE: (619) 564-2246
,5�
+ 4
•NOTE:..
With proper validation
this form constitutes an
encroachment permit CITY OF . LA QUINTA
APPLICATION FOR PERMIT '4
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
DATE: May 7,-1990
LOCATION OF CONSTRUCTION move equipment
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if, appropriate)
DESCRIPTION -OF CONSTRUCTION Cat b4J scraper HAUL ROUTE:, WASHINGTON AND Ave.
52 to Washington and Hwy 111 and
return
DIMENSION OF, INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED HAUL DATE: May 7, 1990
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETIONS
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction ,and placing permanent resurfacing' and/or replacing improvements) l
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 works
,/Signatbre of Applicant or Agent
KAxnmi a PO Rnx A?7 TAtnnrttl.a r rA, 42no
Name of Applicant (please print) Business Address • Telephone No.
'Name of Contractor and Job Foreman Business Address Telephone No.
on f ile
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 tp
Minor Improvement Permit — Class IV: See attached schedule 06f)9
Inspection Fee $ PERMIT VALIDATION'
10.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10 00
Receipt No.
Received by Date
Recorded by
PERMIT NO. 0629
DATE APPROVED 5/7/90 %
5/7/90
EXPIRATION DATE
DATE ISSUED / 5/7/90
By 4 %4_rAA..1�
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS, CONSTRUCTION (ENCROACHMENT)
Foe 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:
LOCATION OF CONSTRUCTION
.(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION ON
DIMENSION OF INSTAL TION,OR_REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Subdivision Improvement Permit — Class III -------
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
lA-9 16�'7o AJ
i9-AA/ 1.P.. -11V *A�
4
APPROXIMATE TIME WHEN WORK WILL BEGIN ~
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Inrludinn removal of all obstruction, materials, and debris, backfilling, eam-
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 prgmriy
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.
Sin ure of Applicant or Agent
♦
Zo L646 .? 0- &o x 1 z W ._,-:; C is C # 9.:?- Y 90
Name of Applicant (please 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 I II
Public improvements: 395 of estimated construction costs
Private improvements: 3% of estimated construction costs NO
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ I' PERMIT VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by '
I
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246