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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 4
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
i
DATE: May 24, 1990
.Subdivision Improvement Permit — Class I
Minor Improvement Permit Class IV
LOCATION,OF CONSTRUCTION move. eaukoment
(Street address or Description of Location)
.PURPOSE OF CONSTRUCTION Pat 633 anW- Tar Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 1 5 2" b., Z 1 65 "11. x,ht legal
'HAUL ROUTE: WASHINGTON AND MILES
DIMENSION OF INSTALLATION' OR REMOVAL NORTH ON WASHINGTON TO I-10
SIZE OF EXCAVATION, IF NEEDED
HAUL DATE: May 24, 1990.
APPROXIMATE TIME WHEN WORK WILL BEGIN:
47 U
PILOT CAR REQUIRED
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 Auihority 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.
ti
Signature of Applica`�or Agent.
rr
Cal Permits PO:Box 799' an Beinardino CA 92402
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 -111
Public improvements: 3% of estimated construction costs i 461 p5 4-•90 ().011
0
Private improvements: 3% of estimated construction costs �1S
`CA „1 T TF;t ~' 1
Minor Improvement Permit — Class IV: See attached schedule
•
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
.10.00
$ 1n nn
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 0661
DATE APPROVED 5./24/90
EXPIRATION DATE 5/24/90
DATE ISSUED / 5/24/90
By
Administrative Authority
TELEPHONE: (619) 564-2246
<— — G — — — — — 4 w — — — — W GCy C,. to Y — ter— — — w rr — N — — 6 G r 4 — M — —
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONRE TRIP OVERSIZE LOAD PER:-1IT
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
DATE: Nay 24, 1990 Minor Improvement Permit Class.IV
LOCATION OF CONSTRUCTION nova ecru ipment
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION +r'a't' 6,11 ortc— par Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 15"22 b0 -4''61-- T -night 109€1-1
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 2
HAUL ROUTE: [JASHINCTON AND MILES
NORTH ON VIASHINGTON TO I-10
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;
HAUL DATE.- Flay 24, 1990
PILOT CAR REQUIRED
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.
Z,,
,Signature of Applicant�or Agent
Cal Parmitn PO Box 799 San Bernardino CA 92402
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
on filo
Contractor's License No.
on f ile
City Business License No.
on filo
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 1 R - on
Receipt No
Received by Date
Recorded by
p
PERMIT VALIDATION
PERMIT NO. 0661
DATE APPROVED 5/24/90
EXPIRATION DATE
5/24/90
DATE ISSUED5/24/90
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)
N
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 III'
DATE: ` �`� Minor Improveme Perm•t lass IV
LOCAT�Ig�N OF CONSTRUCTION B
1 kl-
(Street addreWor Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
i!ncludinu remota:! cf all obstruction, mateeials,'and debris, backfilling, corn- _
paction and'placing permanent resurfacing and/or replacing improvements)
In consideration. of the granting ,of this permit, the applicant hereby agrees to:
I ndemnify, 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 theAdministrative 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
C
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 I I
Public improvements: 3% of estimated construction costs '
Private improvements:'3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule �O
Inspection Fee
Permit Fee
S
'i
Penalty {
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by
Recorded by,
r,
Date
j, PERMIT' VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619).564-2246
t
TRANSPORTATION PERMIT
CALIF $IsYR DEPARTMENT OF TRANSPORTATION `AMGHARGE TO DRIVER •
r-_MT�iI-VCD(' A/G'i'll//1DY',
IN COMPUAr:CE WITH YOUR REQUEST AND SUBJECT TO Affi;-0w';,Ab L;dbfdlV
TIONS AKD RESTRICTIONS WRITTEN BELOW AND THE ATTACHMENTS, PERMISSION IS '
PERMITVALID BETWEEN
-
HER&LY GRANTED TO:
c
r
NAME
�G�iL,•/it S QCs ��,
PM
AND SUNSET
MOVING AUTHORIZED
YES. NNOO
DIST. n
9 8-8 1 5 9
ADDRESS I
CITY/STATE
//�� �` //
GrT�-J.. d LC.2 Z , `z, %
SATURDAY ❑ ��)}
SUNDAY ❑ �J
SUNSET TO SUNRISE: ❑
`
PH NE
HCD.
NO /V �.C�
t�OZ
AUTHO 0 STA PRESENTATIVE
HAUL
LOAD EQUIPMENT
6N MODEL3 � NO. � Ems--
C'
TELECOPIED PERMITS NOT VALID, WITHOUT SEAL.
❑ DRIVE
❑ TOW
TYPE VEHICLE
KING PIN TO
LAST AXIS /1 /
COMB. VEHICLE
LENGTH Q
SENDING STATION
RECEIVING STATION
// Z
3 OP
/
LOADED DIMENSIONS DIFFERENT THAN OR WEIG14TS EXCEEDING THOSE SHOWN BELOW ARE NOT AUTHORIZED
MAX /
HEIGHT: `�
MAX / /
WIDTH: 3 /
•J CCCJJJ3
MAX /
OVERALL LENGTH: �O
MAX
OVERHANG: L�G.4
AXLE NUMBER
1
2
4
S
6
7
8
9
NUMBER TIRES
AXLE SPACING
/
/
Z 3
s 9
`f
6
AXLE WIDTH
WEIGHT
�62/670.9
ORIGIN
DESTINATION
TRIPS
AUTHORIZED STATE HIGHWAYS COUNTY AND/OR CITY PERMITS REQUIRED.
1
T.
� � •.; :^..�,�? S it � ,v i � .T+O f/ — n�Grr�r sf :� n.'
.
7' -/67,1:;',7_--'r_- -./
C� ic- - 9-S (z) ^-'- - 1
i .
i
PILOT CAR YES. '❑ NONE REQUIRED
i
ATTACHMENTS
p
lL L - ( I T_ `— 1
❑X PERMIT CONDITIONS
❑
. 4
❑
❑
❑ CASH
I CERTIFY THAT ALL COUNTY AND/OR CITY TRANSPORTATION PERMITS
CHARGE FEE:Irf;�
HAVE BEEN O TAINED IF THIS PERMIT IS FOR TOWING A MOBILEHOME
❑
❑ EXEMPT �' 3
/DATE ��
❑
,o�-AUTHCMZED AGENT SIGNATURE
DM-M-P-I6(Rev.1.89) . ORiG—Permittee (� 89 86/8
N