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Wro erwvalidation
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p p off.
this forrn'constitutes an -
CITY OF. LA QUINTA ,
encroachment'permit
" APPLICATION FOR PERMIT --
ti
PUBLIC; WORKS CONSTRUCTION .(ENCROACHMENT)��
-f ®NE'.;TRIP OVERSIZE. LOAD PERMIT : OFT[i8�
4. -r
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
'gay -10; 1990 Subdivision Improvement Permit— Class III '
DATE:' Minor Improvement Permit Class IV
LOCATION .OF CONSTRUCTION move, equipment r ' n
(Street address or Description of Location) + ,
PURPOSE OF CONSTRUCTION ' ``" Sketch (attach construction, plans if appropriate).'• s
DESCRIPTION OF CONSTRUCTION t.n ti,1eA�
- 1n'ti"`wide. 1.S' hiah.•96.000 lbs _ 'HAUL'ROUTE: BERMUDAS NORTH TO•'
- AVENUE 52 EAST TO�WASHINGTONNORTH.
DIMENSION OF INSTALLATION OR REMOVAL' TO 'FRED. WARING
' . HAUL DATE: May . 10 , 1990 or •
SIZE OF EXCAVATI'ON;,IF NEEDED May'"11., '1990
APPROXIMATE TIME WHEN WORK WILL BEGIN r ONE DAY' ONLY * ;
.APPROXIMATE TIME OF,COMPLETION ' t
ESTIMATED CONSTRUCTION COST $.
(Including -removal of'all obstruction,.miterials,, and debris, backfilling, com
paction and placing permanent. resurfacing and/or replacing improvements) `.
>F i,
4 t 'In consideration, th'e granting of this permit; the applicant hereby agrees to:` .
• 1 '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. y
Comply with all applicable City Ordinances, the terms and'conditions'of the permit and all applicable rules an®ulations of -the City of .
t La Quinta'and.to pay for -,any additional replacement necessary `as the result of this works - '
Signature of"Applicant or Agent. r
• t-Massev Sand' 'and' Rock Co PO Box 1767 indio, .' CA 92201 •
Name of Applicant'(please print)` ' •2 Business Address '' 005182 10 T'eephone lVo``/0 i4'
,, 10 CASH i 413e'
r 1U.00
• 4 .. ~- -.
'. Name of Contractor and Job Foreman`', M Business Address ti - Telephone No:;,•
on file �' . • ori file t I • .
; 4 '' City Business License N
Contractor's License No. o. , '• -
•on, file.
Applicant's Insurance Company Policy:Number-` '
,
,FEES:. Subdivision lmprovemenf'Permit -Class III
Public improvements::3% of estimated construction cost's
Private improvements: 3% of Atimated'construction costs o `.�
.
Minor Improvement Permit - Class IV: See attached schedule. '
„+ 'Inspection Fee' $ PERMIT VALIDATION
Permit Fee 10:00
PERMIT NO. 0636
Penalty - '; , ; • 5 / 10 / 9 0 +'
DATE APPROVED i
Cash Deposit -Surety Bond <' 4
'if required EXPIRATION DATE 5/11/90. ,
TOTAL: $' 10'.001 ' , : *. 5 / 10.19 0 l Y .
c ' DATE ISSUED `
Receipt No. a Jc7/4-�e,I
r By
Received b '
. y Date t Administrative Authority 't
Recorded by • n TELEPHONE: (619) 564-2246- `
t
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
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
4 r .
May 10, 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 CONSTRUCTION +_- 1 A 'kI -n—A
1.016" wide. 15' high, 96,000 lbs'^ HAUL ROUTE: BERMUDAS NORTH TO
AVENUE 52 EAST TO WASHINGTONNORTH
DIMENSION OF INSTALLATION OR REMOVAL TO FRED WARING
HAUL DATE: May 10, 1990 or
SIZE OF EXCAVATION, IF NEEDED May 11, 1990
APPROXIMATE TIME WHEN WORK WILL BEGIN ONE DAY ONLY
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 Agp nt
Massey Sand and ROCk Co PO Box 1767 Indio, CA 92201
Name of Applicant (please print) Business Address 005.t82 Telephone No`y0 14
io CA.�Fi f IGfAL x ioloo
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 I I I
Public improvements: 3% of estimated construction costs
Private improvements:, 3% of estimated cohstruction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ jr
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
No 06UG
N
PERMIT VALIDATION
PERMIT NO. 0636
DATE APPROVED 5/10/90
EXPIRATION DATE • 5/11/90
DATE ISSUED 5/10/90
By
t 4 Administrative Authority
Recorded by 11 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)
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 Ill
DATE:—�� — Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location) A
PURPOSE OF CONSTRUCTION
DESCRIPTION OF%CONSTR
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLET iON�-
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction
om paction .and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting.of this permit, -the applicant. hereby a,grees.tc:
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, foss 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 Quints and to pay for any additional replacement necessary as the result of this work.
Name of Applican gplease print)
Signature of
Business Address
icant or Age
Im
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No: City Business- cense No.
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.
Received by. Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246