0641CW..
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
, ONETRIP 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 16, 1990 Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF'CONSTRUCTION MOVE EUQIPMENT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION •D-6 dozer 11110" -wide
hoi,crht and weiaht 11aal HAUL ROUTE: MONTEZUMA AND
AVENIDA SINOLOA EAST ON Ave. 52
DIMENSION OF INSTALLATION OR REMOVAL and North on Washington and .west
K on Hwy 111 out of City 'limits
SIZE OF EXCAVATION, IF NEEDED
'
APPROXIMATE TIME WHEN WORK WILL BEGIN Haul, Date: May 16, 1990
Pilot car 4nd traffic (wide load)
APPROXIMATE TIME OF COMPLETIONgignS required
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, •backfill ing, 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,,aga nst any and all.
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penalties, liabilities or loss .resulting from claims or court action and arising out of any. accident, ss ortdiam�atge�tb p�elrs�o�s or propeiyj00
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 Applicant or Agent
�.
• Massey Sand and .Rock 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.
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 II
Public improvements: 3%0 of estimated construction costs
Private improvements: 3% of estimated construction costs
Q 0
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ F, . PERMIT VALIDATION
Permit Fee 10.00 0641:
PERMIT NO.
Penalty 5/16/90
Cash Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE 5/16/90
TOTAL: $ 10.00
DATE ISSUED -- 5/16/90
Receipt No.
By—
Received
y Received by Date Administrative Authority
Recorded by'- TELEPHONE: (619) 564-2246
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WOh proper validation
this form constitutes an o T
• encroachment permit, CITY,OF LA QUINTA,
APPLICATION FOR PERMIT
r PUBLIC.. WORKS CONSTRUCTION .(ENCROACHMENT)
c�
ON$TRIP'OVERSIZE LOAD PERMIT
SOF
• p p y p parkin lots, sewers, water `mains
,For. the. construction of public or rivate curbs, driveways, pavements, sidewalks, g
F and other like public works improvements'in,connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS • '
Mar .. 16 1990' Subdivision Improvement Permit 1''Class lll.
DATE: y ;` Minor Improvement Permit Class IV.
�LOCATION OF'CONSTRUCTION MOVE EUQIPMENT
(Street.address or Description of. Location)
PURPOSE OF CONSTRUCTION- Sketch (attach construction plansi,f appropriate)
DESCRIPTION OF CONSTRUCTION.
''D_6.dozer 11' 10" wide -
DESCRIPTION
' hP3 arht and wei.aht 1.&aal. • HAUL ROUTE : , : MONTEZUMA AND,,.
AVENIDA SINOLOA EAST ON: Ave. 52
DIMENSION.OF INSTALLATION OR REMOVAL and North on'Washington' and .west, `
on. Hwy 111 'out . of City limits
SIZE OF EXCAVATION, IF. NEEDED
APPROXIMATE:TIME WHEN WORK WILL BEGIN Haul Date: May •.16, 1990
Pilot car and - traffic .(wide load)
APPROXIMATE TIME'OF.COMPLETION.' • signs required, ,
ESTIMATED CONSTRUCTION COST $ t. ,
l' (Including removal'. of all obstruction, materials, and debris, backfilling, com •• `
paction and•placirg 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
OtAlimY W 44 a tds- �+ YU f 4
penalties,. liabilities or' loss resulting from claims or court action and arising,out of any accident; loss or damage• to? ersons.or propertyj�Q0
It • .l td �1H) .l. 1 4111"L .1
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. o
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.
r
• Signature of Applicant or Agent
Massev wand and Rode PO.'Box 1767 Indio, CA`92201' S
Name of Applicant (please print). Business Address _ Telephone No.
i
Name of'Contractor and Job Foreman 'Business Address Telephone.No.•
i'•
on, file � - .. on file ,
Contractor's License No., City Business License No. f A
on file ;
Applicant'sns'urance' Company - u Policy.Number
FEES: Subdivision Improvement Permit Class'III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs p{f, Q �e d,�
(" U' 6
Minor. Improvement Permit — Class IV: See attached schedule A, '
Inspection Fee -$'r PERMIT VALIDATION < ,
Permit Fee" 10.00 PERMIT N0. 0641
f . ,'
Penalty
DATE APPROVED 5'/,16/90'
Cash Deposit -Surety Bond {
9 0.
if required 5/16)
EXPIRATION DATE
$ 0 00
TOTAL: 1.
DATE ISSUED I'/16/90
Receipt No.
By
Received by 'Date• Administrative Autliority
Recorded by TELEPHONE: (619) 564-2246
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Al,