0630NOTE:
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
May 18, 1990 Subdivision Improvement Permit — Class III
DATE:Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION mwca Pcxtti.nmPni-.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION 13-5 Dozers 11110'"
height and weight legal
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
HAUL ROUTE: WASHINGTON Ari
T4ARING SOUTH TO AVE. 5
Ave. 52 and' South on BE' -7,K",
COLIMA
SIZE OF EXCAVATION, IF NEEDED
HAUL DATE: May 18® 199
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. �
Signature of Applicant or Agent x J
Massey Sand and,Roc k Co. PO Box 1767 Indio, CA 92201
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
nn fila nn filo
Contractor's License No., City Business License No.
on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement.Permit —Class I I I
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
10.00
P1. enalty
,Cash Deposit -Surety Bond .
if required
TOTAL: !: $ 10.00
Receipt No. .
Received by Date
10 CA"? �a
PERMIT VALIDATION
PERMIT NO-. 0630
DATE APPROVED 5/18/90
EXPIRATION DATE S /1 R /qn
DATE ISSUED 5/18/90
r
By
Administrative Authority
Recorded by II' TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an
encroachment permit
a
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 18, 1990 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
�a
LOCATION OF CONSTRUCTION move nrxtzinment
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION D-6 d02ers 11110'.
height and weight Legal HAUL ROUTE: TIASHINGTON..AT FRED
11ARING SOUTH TO AVE. 52 NEST on
DIMENSION OF INSTALLATION OR REMOVAL Ave. 52 and South on BEP11UDAS TO
COLIMA
"I-
SIZE;OF EXCAVATION, IF NEEDED
HAUL DATE: May 18, 1990
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF CON PLETION
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.
'11114 \1
Signature of Applicant or Agent —�
Massey Sand -and Roc h Co. PO Box 1767 Indio, CA J0�'01
Name of Applicant (please print) Business Address Telephone No.
- 1
Name of Contractor and Job Foreman Business Address Telephone No.
on file on file
Contractor's License No. City Business License No.
a
on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT NO
PERMIT VALIDATION
0630
DATE APPROVED
518/90
EXPIRATION DATE 5/18/90
DATE ISSUED 5/18/90
� 7
By
Administrative Authority
TELEPHONE: (619) 564-2246
low
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 18, 1990 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
�a
LOCATION OF CONSTRUCTION move nrxtzinment
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION D-6 d02ers 11110'.
height and weight Legal HAUL ROUTE: TIASHINGTON..AT FRED
11ARING SOUTH TO AVE. 52 NEST on
DIMENSION OF INSTALLATION OR REMOVAL Ave. 52 and South on BEP11UDAS TO
COLIMA
"I-
SIZE;OF EXCAVATION, IF NEEDED
HAUL DATE: May 18, 1990
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF CON PLETION
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.
'11114 \1
Signature of Applicant or Agent —�
Massey Sand -and Roc h Co. PO Box 1767 Indio, CA J0�'01
Name of Applicant (please print) Business Address Telephone No.
- 1
Name of Contractor and Job Foreman Business Address Telephone No.
on file on file
Contractor's License No. City Business License No.
a
on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT NO
PERMIT VALIDATION
0630
DATE APPROVED
518/90
EXPIRATION DATE 5/18/90
DATE ISSUED 5/18/90
� 7
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) k
.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 II
DATE: �v Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION ,
IV
(Street address or Description of Location) _
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF NSTRU ION
L-
GlY /A(
DIMEN V ON OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION IF NEEDED
• U�yv
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.
S' nature of AgplIcant Agent
ame of Applica t (please print) Business Address Telephone No.
Name of Contractor and J b Fo eman Business Address Telepho No.
J
Contractor'ss,Liccens o o: -City Business Lice o.
f Z�
�
Applicant's Insura4e Company Policy Number
FEES: Subdivision Improvement Permit — Class 111 .
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.
Recgived by Me
Recorded by
�O
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Admirliwative Authority
TELEPHONE: (619).564-2246