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NOTE:
With proper validation
this form constitutes an
encroachment permit
0
CITY .OF LA QUINTA '
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE 111P•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
Subdivision Improvement Permit - Class I I I
DATE: June' 5, 1990 Minor Improvement.Permit Class IV
LOCATION OF''CONSTRUCTION move ecrusument
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans. if appropriate)
DESCRIPTION OF CONSTRUCTION HAUL ROUTE: Washington South
to. Ave.. 52 1 mile east
623 B Scraper on Ave. 52
DIMENSION OF INSTALLATION,OR REMOVAL
14'' x 12 w 119 ,138 lbs14
MOVE�OpI�tf
1,924 9i %_90 10.00
*.
SIZE OF EXCAVATION, IF NEEDED y
APPROXIMATE TIME WHEN WORK WILL BEGIN 6/6/90
APPROXIMATE TIME OF COMPLETION 6/6/90 y
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
IA consideration of the granting of this permit; the applicant hereby agrees to:
Iridemnify,.clefend 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 u-nder.the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when workwill 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.
Sign�tume of Applicant or Agent .
Nuevo Enftneering 79811 Country Club Bermuda Dunes. CA 345-1778
Name of Applicant (please print) Business Address Telephone No.
Dalton Trucking 13560 Whittman Fontana,'CA -92335
Name of Contractor and Job Foreman Business Address Telephone No.
on file ori file
Contractor's License No. City Business License No. .
Farmers Ins. 600221517
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: $ 10.00
Receipt No.
Received by Date
Recorded by
N° 0679
PERMIT VALIDATION
PERMIT NO. D1;74
DATE APPROVED 6/5%90
EXPIRATION DATE 6/15/90
DATE ISSUED"' /6/5/90
By—
Administrative Authority
TELEPHONE: (619) 564-2246
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NOTE:
With proper validation 2
• O
this'form constitutes an 1
encroachment permit CITY OF LA QUINTA
"APPLICATION• FOR -PERMIT
PUBLIC WORKS CONSTRUCTION .(ENCROACHMENT)
ONE .TAMC 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
Subdivision Improvement Permit = Class II I
'June . 5, -.1990'.. ;` '
• DATE: ", Minor Improvement Permit Class IV -
LOCATION OF CONSTRUCTION move .ectuinment
(Street address or Description'of Location)` "
PURPOSE OF CONSTRUCTION_. Sketch (attach construction plans if appropriate) `
DESCRIPTION OF CONSTRUCTION HAUS R W
OUTE:
ashington South'
to Ave. -52 1'mile east .
DIMENSION OF INSTALLATION OR REMOVAL—
'623 B- Scraper' on Ave. 52, '
14 x 12 w •119';138 'lbs.
MOVE ppr
ia0J1"1� 4�T�?�'��91��vQ �.O.S3U i4
SIZEtPF EXCAVATION; IF,NEEDED
APPROXIMATE TIME WHEN'WORK WILL BEGIN.6/6/9.0
^APPROXIMATE TIME.OF COMPLETION •6/6/90 }
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
1 `
:penalties? liabilities -or loss-`iresulting from claims oircourt 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)•hoursjn•advance.of the time when work, wiII be,stirted.
' Comply with.all applicable..City Ordinances, the terms and'conditions of the permit and.all applicable rules a.nd.regulations of the City of
La,Quinta and to pay for any additional replacementrnecessary as the'result'of this work. '''_ Y • 'E `'
Si nature f A licant'or A gent
h
o
, PP 9
9 1
s Nuevo Enftneering ` .7981.1 Country. Club Bermuda Dunesm, SCA " 345-1778__
Name of Applicant (please -print) , Business Address Telephone No.
Dalton,Truckinq 13560 Wh ttman .. Fontana, CA 92335
w t
Name of Contractor and'Job Foreman Business Address Telephone No.
on file f on file
Contractor's' License No. CitV,Busiriess.Liciense No.
'Farmers Ins. j 6002215.17 ) '
'Applicant's Insurance Company` '' ' Policy Number. .
FEES: S6bdivision'Im0rove'ment Permit -Class III ,.
Public improvements: 3% of estimated construction costs
Private improvements'. 3% of estimates construction costs''
Minor Improvement Permit'—'Class IV: See attached. schedule
Inspection Fee $ PERMIT VALIDATION
Permit Fee' 10.,00 ,
PERMIT NO.
'Penalty,
" , .
Cash Deposit -Surety Bond DATE APPROVED 6/5/90
if required6/6/90
L EXPIRATION DATE'
TOTAL: $1 10.00 `ty .. l '_ ,',;�. (6/5/90
DATE ISSUED- '
Receipt No. '1 '
Received.by Date Administrative Authority
Recorded by' 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 111 I
DATE: �Q Minor Improvement Permit Class IV
.LOCATION OF CONSTRUCTION OV �Q S ► Z� L,.A �
(Street addressor Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INVALLATIOWOR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME TIME WHEN WORK WILL BEGIN —� + q l Z
APPROXIMATE TIME OF COMPLETION -LO
—L"
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and deb: -is, backfilling, com
acing permanent resurfacing and/or replacing improvements)
paction and pl
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, Aefend 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 124) 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
Name of Applicant (please print) Business Address Telephone No.
<cJ 1 '� S1.�� u%��t�'�pr� ��tJ}A �A C� 23 3
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
Inspection,Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
$
TOTAL: $
Receipt No.
Received by Date
Recorded by
NO
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246