0719NOTE:
With proper validation,
this form constitutes an
encroachment permit
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
June 25, 1990 Subdivision .Improvement.Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION move equipment
(Street address or Description of`Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 637 scraper 131811 h
13,' w, 144,325 HAUL DATE: June 25, 1990
-- - - HAUL ROUTE: AVE. 48th and
DIMENSION OF INSTALLATION OR REMOVAL Washington north to Out of City
limits
SIZE OF EXCAVATION, IF NEEDED '
APPROXIMATE TIME WHEN WORK WILL BEGIN 9 l
APPROXIMATE TIME OF COMPLETION
—ESTIMATED CONSTRUCTION COST $,
(Including.removal.of all obstruction, materials, and debris, backfilling, com-
paction andlplacing 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 6th1)SWokK,,.
Signature�Ri Applicant or Agent
Nuevo Engineering- 79-811 Country Club Bermuda Duess'
Name of.Applicant (please print) Business Address Telephone No.
Remmis
Name of Contractor and Job Foreman Business Address Telephone No.
.438834 157
Contractor's License No. City Business License No.
Wilshire Ins. BA 2462157-57-02
Applicant's Insurance Company Policy. Number i
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
0045i8CASH i TUUTAL �5-y0 10.001G
Ns 0719
PERMIT VALIDATION
PERMIT NO. 0719
DATE APPROVED A 19 r �'a n
EXPIRATION DATE 6/25/90
DATE ISSUED 6/25/90
By
Recorded by TELEPHONE: (619) 564-2246
Administrative Authority
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S
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
n w't
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
. •I..0.. .'f.. -• S .
DATE: June 25, 1990
LOCATION OF CONSTRUCTION move
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
ipment f
j
DESCRIPTION OF CONSTRUCTION 637 scraper 131811 h
13.' w, 144,325 x
Sketch (attach c no struction plans if approp"ri e)
HAUL DATE: June 25, 1990
HAUL ROUTE: AVE. 48th and
DIMENSION OF. -INSTALLATION OR REMOVAL Washington north to out of City
limits
SIZE OF EXCAVATION, IF NEEDED
� � C� C. C� `i Cts L9.. \ Y ��•�J`�.
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.:
3
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.
Signaturefior Applicant or Agent
Nuevo Engineering 79-811 Country Club Bermuda Du®es
Name of Applicant (please print) Business Address' . Telephone No.
Remmis
Name of Contractor and Job Foreman Business Address Telephone No.
438834 157- t
Contractor's License No. City Business License No.
Wilshire,Ins. BA 2462157-57-02
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.
10.00
$ • 10.00
Received by Date
Recorded by
4
PERMIT NO:
f4�i� A19 a?'WTA! ~i /v i0.001v
0713
-PERMIT VALIDATION
0719
DATE APPROVED 6/25/90
EXPIRATION DATE 6/25/90
DATE ISSUED 6/25/90
By
Administrative Authority
TELEPHONE: (619) 564-2246
a