0664-1
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 PER£?IT
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
tw.
DATE
LOCATION OF CONSTRUCTION OVERSIZE LOAD
(Street address or Description of Location)
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
PURPOSE OF CONSTRUCTION Sketch -(attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
CAT 623b SCRAPER 14 H 11 10 W 119 136 LBS
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETIONr!?CW 1� A�►
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 ROUTE AVE 448th
VMSHINGTON TO H11Y 111
Indemnify, -defend and save the City, its authorized agents, officers, Pepresentatives 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. 1
ure of Applicant or Agent
MTT7G'tln 'F'%T(-TMRV.RTAT(, 7Q—R11 r aTTmmy OT.Tln nn
Name of Applicant (please print) Business Address Telephone No.
t)TrQMT MPTTf''TLTMa
Name of Contractor and Job Foreman Business Address Telephone No.
3Q-QZA:
Contractor's License No.
City Business License 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.
$ 1.0.00
Received by Date
d 502 10 4637 05-25-90 4 i �
6 LASH !. YOTAL i io.00
PERMIT VALIDATION
PERMIT NO. 06x4
DATE APPROVED 5/25/90
EXPIRATION DATE,r 5/29/90
DATE,I�SS Qn
I . —
Administrative Authority
Recorded by I1 TELEPHONE: (619) 564-2246
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NOTE:
a
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
%W
DATE:
LOCATION OF CONSTRUCTION OVERSIZE LOAD
(Street address or Description of Location)
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION HAUL ROUTE AVE 48th
WASHINGTON TO HWY 111
DIMENSION OF INSTALLATION OR REEMOVAL
CAT 623b SCRAPER 1- tI 11 10 W liv 1JB Lf3b
SIZECOF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
5 /2a /an
APPROXIMATE TIME OF COMPLETION g /Qn
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
Ni1F170 F.NGTNEEkRTNG 79-811 COUNTRY CLUB DR
Name of Applicant (please print) Business Address Telephone No.
PTrQNT TR[ICXTNG
Name of Contractor and Job Foreman Business Address Telephone No.
43fiAIA -
Contractor's License No. City Business License No.
Applicant's Insurance Company { Policy Number
FEES: Subdivision Improvement Permit — Class III ? i85i$ q�y37 p
!1 5 �2S•�9G i�?. E1 , i4
Public improvements: 3% of estimated construction costs .
1 T01 At. 1 0
Private improvements: 3% of estimated construction costs
0664
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 10.00
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 0664
DATE APPROVED 5/25/90
EXPIRATION DATE
5/24/90
DATE. I SU D `�175126
-=
By �
7�,
Administrative Authority
TELEPHONE: (619) 564-2246