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` NOTE:
With proper validation rt 2
this form constitutes an
encroachment permit CITY OF LA QUINTA U
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
One. trip oversize load permit ' OF�ti
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 s
DATE: 6-15-90. Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION ' t
j
(Streef address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
Haul RoutSe; ;.
DESCRIPTION OF CONSTRUCTION Barber Greene �2x3==Xkt 4 24X *
Pavina Machine 10ft bin wide
• Hiea t.Wieath 1eaa1 �x>��:�•�x�sxxx
Washington to 52,west to .
DIMENSION OF INSTALLATION OR REMOVAL
west to ramirez.
SIZE OF EXCAVATION, IF NEEDED
Haul -Date :1
APPROXIMATE TIME WHEN WORK WILL BEGIN 61 18-90 .
r
APPROXIMATE TIME OF COMPLETIONTIT. 31
v�
ESTIMATED CONSTRUCTION COST $ _ QQ9 Aacr' .nnlsz
(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 df this work.
za_
Signature of Applicant or Agent
Massey Sand& R Ck P.O.Box 1767 Indio CA 922Q�X
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 f Policy Number
v -
FEES: Subdivision Improvement Permit — Class I I
Public improvements: 3% of estimated construction costs 1 1
0005i&� O 5123 06115-90 t0.�0 10
Private improvements: 3% of estimated construction costs �To 0 7I
Minor Improvement Permit — Class IV: See attached schedule 1`�
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 1.0 � 0 0
Receipt No.
Received by
Date
�t PERMIT VALIDATION
PERMIT NO."N' •0704
DATE APPROVED 6."15-90
EXPIRATION DATE 6-19-90
Y
DATE ISSUED
B y
` Administrative Authority
Recorded by II TELEPHONE: (619) 564-2246
••e�-�4w+•sK?^`4"•'�'�?7a4e+M+r�Mw�tr� s:..w. r w. r:. r. y r .�.a+,it+• .... r w o r w. w-.r..h' r w.. r .�. w' 6 �ti_ ± w�. w 7•�+.• .o r..:..w• M:. �r .... a...� •r .� o.. w •wN. ^w. •�. •o
NOTE:
With proper validation
this form constitutes an
encroachment permit
Yr .
C
CITY OF LA QUINTA
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: 6—.15-90 ,r Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION m=use
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Barber Greene
Pavina Machine loft 6in wide
Hieaht,Wieath leaal
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Haul Route;
,§aXZ x=ltslattXV*XMX> x
x»t CXjjtt,*3xxx
Washington to 52 west to
bermudas south to colima
west to ramirez
Haul Date
6-18-90
�i APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $p av Only
(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. /
Massey Sand & Rock
Name of Applicant (please print)
Signature of Applicant or Agent
P.O.Box 1767 Indio CA 922
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
,I
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class II I
Public improvements: 3% of estimated construction costs 18`16'
5 2� f36�-•15-90 io
Private improvements: 3% of estimated construction costs qui - $ iin OT L 1 10,f10
Minor Improvement Permit — Class IV: See attached schedule 12 `0 V
Inspection Fee $
Permit Fee 10.00
Penalty
-Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
it
DATE APPROVED 6-15-90
EXPIRATION DATE 6-19-90
DATE ISSUED'" 6-15-90
By ,
` l/ 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 (ENCROACHMEN )
ohe. jJ oue'rsi� l0rx. PP�✓� �'..
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
/670Subdivision Improvement Permit — Class III
DATE: (P Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION j2x1 C o e- @DI 11 1'0 /Y)Pzj�
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if, appropriate)
DESCRIPTION OF CONSTRUCTION'77 ` Ilatt( L64X� —
to iQ A;o] 0
DIMENSION OF INSTAL ATION OR REfAOVAL /
SIZE OF EXCAVATION, IF NEEDED QS / /d €�i /Yl(-f-doS
�d
APPROXIMATE TIME WHEN WORK WILL BEGIN km -CL
APPROXIMATE TIME OF COMPLETR)N 40 r
ESTIMATED CONSTRUCTION COST $ �
.(Including removal of all obstruction, materials, and debris, backfilling, com. �l�u ,,Oal e
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 ail 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.
Applicant or Agent
1 l 5 S C.1
5e? dt V- 1)e� / t1,e Z � �l r' O a
Name of Appli ant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
(M -rile
Contractor's License No. City Business License No.
-
Appiicant's Insurance Company Policy Number ,
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs
Privgto improvements; 3% of eitimated Ggngtrumion GBiti
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL; - ..
pbulvod by -- --- -- --- Date T -_z
Recorded by
N®
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
B
Administrative Authority
TELEPHONE: (619) 564-2246