0709•r F � ,
NOTE:
With proper validation
this form constitutes an
encroachment permit
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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 I II
DATE: 618"90 Minor Improvement Permit.Class IV
• ti
LOCATION OF CONSTRUCTION MOVE. EQUIPMENT r
- d
(Street address or Description of Location)
PURPOSE OF_CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION �"!#91AT 1naA�r' HAUL ROUTEROU
i.A1.�!!417T. F -iii r,11 ><TTr_u Trrr_T L.IET !LYT WASHINGTON S/b:
FIB to
DIMENSION OF INSTALLATION OR REMOVAL RONDO
ROME DATE , 6-18-90
SIZE OF.EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK -WILL BEGIN
r psi 8—an
APPROXIMATE TIME OF. COMPLETION
005j,%
51yASNQ 1 i'QiALbri S .94 10,00 i4
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, lossor'damage to persons or property .
happening, or+occurring'as-a. proximate result of any work undertaken under the permit granted pursuant to this application. s
Notify the Administrative Authority at least twenty-four. (24) hours in advance of thetimewhen 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.
i Signature of Applicant or Agent J
MASSEY SAND AND ROCFjftF4F4 P.O< OBOX. 1797 INDIO CA
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
ON FIT F ON FTT T'
Contractor's License No. City Business License No.
ON FTT IF
Applicant's Insurance Company Policy Number
FEES: Subdivision -Improvement Permit —Class II I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit = Class•IV: See attached schedule 0709
Inspection Fee $ PERMIT VALIDATION
Permit Fee iA j)A
Penalty '
Cash Deposit -Surety Bond
if required,
TOTAL: $ 10.00
Receipt No.
Received by Date
PERMIT NO. 0709
DATE APPROVED 6=18-90
EXPIRATION DATE 6-18-90
DATE ISSUED /' 6-18-90
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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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 III
DATE: 6918-90 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOE. EMIPHW
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION �f('AT ����*' HAUL ROUTE
1 n fall f,,,taT`n1~ i/00 uwu T Pr. AT _. [.1FTr4ff` WASHMGi'ON ' S /b
EVIX100 EIR to
DIMENSION OF INSTALLATION OR REMOVAL RONDO
MX ROM DATE 6-18-%
• t
SIZE OF EXCAVATION, IF NEEDED
Y
APPROXIMATE TIME WHEN WORK WILL BEGIN
IF A-1 R_Cn
APPROXIMATE TIME OF,COMPLETION 005ia,) 0 S 47 1}46--0-90 14
ESTIMATED CONSTRUCTION COST $ ip G`As+ i TQTAL 9 i0-00
(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 r
happening or .occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Adm inistrative',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.
L•L
Signature of Applicant or Agent
MASSEY SAND -AND R0110 e� P.0< OBOX 1797 INDIO CA
Name of Applicant (please print).
Business Address
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
r
ON FTI'-: ON FTI :
Contractor's License No. City Business License No.
ON FTM
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
4 Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit - Class IV: See attached schedule Ns 0709
Inspection Fee $
Permit Fee in,An
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10'00
Receipt No.
Received by
Recorded by
Date
PERMIT VALIDATION
0709
PERMIT NO.
6-18-90
DATE APPROVED
EXPIRATION DATE
6-18-90
DATE ISSUED i�
6-18-90
B Y
Administrative Authority
TELEPHONE: (619) 564-2246
• With proper validation
this form constitutes an
CITY. OF LA QUINTA J
encroachment permit
APPLICATION, FOR, PERMIT
PUBLIC WORKS,:CONSTRUCTION. (EN ROAC MENT)
'Sze`
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
DATE:
LOCATION OF CONSTRUCTION
(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. ONST%FTI N
DIMENSION OF INSTALLATION OR REMOVAL
5
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 yvork.
, /_-19 nature
AV-/
Applicant orhgpnt _—
- P/
.
Name of Applicant 1 ease print) Business Address ;Telephone No. C�
)1
1 f
Name of.Contractor and J Foreman Business Address T'lep one No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company
Policy Number
FEES: Subdivision Improvement Permit — Class 111
.••Public improvements: 3% of estimated construction costs
Prime impreVelrlem; 3% gf 115timated Gg(armion com
�� I
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee.: $ I
PERMIT VALIDATION
Permit Fee
PERMIT NO.
Penalty
Cash Deponit -Surety Bond
DATE APPROVED
If required
EXPIRATION DATE
TQTAL; , $.-_._---
DATE ISSUED
Receipt No,
�{ �,
by bate
w •r- a --_ . �^�?v 13_ _4C3ii k3 9i 1 trFf&arte 1#"c_ w?1
Administrative Authority
Recorded by
TELEPHONE: (619) 564-2246