06919X.
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
Subdivision Improvement Permit — Class I I I
DATE: • • ;. Minor Improvement Permit Class IV
V 1 .L - J V
LOCATION OF CONSTRUCTION MOVE EOUZPMENT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION c 11Am T_r_iAr-ivn i nn .C r� T,TTnE Sketch (attach construction plans if appropriate)
A I iG If UTOW T Pf_-AT UTLITOUM
.._r '.��'_,.-
DESCRIPTION OF CONSTRUCTION HAUL ROUTE FRED WARING EW6T TO
WASHINGTON SOUTH TO 52 WEST TO -BE
BERMUDAS SOUTH TO MADRID
DIMENSION OF INSTALLATION.OR REMOVAL
HAUL DATE 6-11-90
SIZE OF.EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
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 Agent
MASSEY SAND AND ROCK P.O. BOX1776.INDIO CA 92202
Name of Applicant (please print)
Business Address
t4
e No. io.00
Name of Contractor and Job Foreman Business Address Telephone No.
n FTT.F. ON FTLF
Contractor's License No. City Business License NO..
(1N FTT.F
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
y ..
Minor. Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 1 n no
Penalty
Cash- Deposit -Surety Bond
if required
TOTAL: $ - -1 n on
Receipt No.'
Received by Date
Recorded by
N2 0691
PERMIT VALIDATION
PERMIT NO. Acol
DATE APPROVED ' 4; -1 1 —9Q
EXPIRATION DATE
V_ L1 J V
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
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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 TRIPOVER5IZE 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: + + 9 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE EQUIPMENT
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 066 f -A rr T n7k nvn 1 n n 611 T,nTg)E
1 A I C II UTr+—TJ T.Vt"_'AT. TAM Tf_T?T
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HAUL ROUTE FRED WARING EW6,T TO
WASHINGTON SOUTH TO 52 WEST TO BI
BERMUDAS SOUTH TO MADRID
HAUL DATE 6-11-90
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. 1
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
MASSEY SAND AND ROCK P.O. BOX.1776 INDIO CA 92202
+..�jName of Applicant (please print)
Business Address
xll
A / .< t 9
9 " �( a
one.K. 'Q, 00 4�r
Name of Contractor and Job Foreman Business Address Telephone No.
can FTT.F ON FILE
Contractor's License No. City Business License No. t
ON FTT.F.
Applicant's Insurance Company Policy Number 4t,if
a
FEES:. Subdivision Improvement Permit — Class I II
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule O
691
Inspection Fee $
Permit Fee 1 n - nn
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ in -nn
'
Receipt No.
Received by Date
Recorded by
i
PERMIT VALIDATION
PERMIT NO. n��1
DATE APPROVED 6-11-90
EXPIRATION DATE rg-1 I
DATE I S D v F -11-9n
By
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an . CITY OF;` LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACH ENT)
J t
• _ .�jrZ•e.. ' T �" �. �}� . O UP.�S % �e
load SOP ✓yr r
For the consteuction 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: / / go .
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
Subdivision Improvement Permit — Class 111
Minor Improvement Permit Class IV
k tch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION j
DIMENSION.OF INSTALLATION OR REMOVAL
-tip �a
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
/`zoo
APPROXIMATE TIME OF COMPLETK)N "i
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.
business Atldress
Name of Contracto and Job Foreman Business Address , Telephone No.
Contractor's L• ensgjNo... City Business icense No.
Applicant's 1wrance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
Privot6 improvements; 3% of 9stinlllted construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Gash Deposit,Surety Bond
if required
TOTAL,; ..
Receipt No.
Aaad Ved by bate
Recorded by
N0
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564.2246