0721NOTE:
With proper validation
ti
this form constitutes an
encroachment permit CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE LOAD REP4IT
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
r (Street address or Description of,Location)
.PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION � w —
a th, 9 l l i aw 1.1 9,1.38 ns, =HAUL ROUTE: Ave -52 -to
Washington north out.of City,
DIMENSION OF INSTALLATION OR REMOVAL limits
SIZE OF EXCAVATION., IF -NEEDED � Haul date: June 25, 1990
APPROXIMATE TIME'WHEN-WO.RK WILL BEGIN
APPROXIMATE •TIME,OF.COMPLE. TION �.
ESTIMATED CONSTRUCTION COST $ ,
(Including removal 'of �all obstruction, materials, and debris, backfilling, com-
paction, and placing permanent resurfacing and/or replacing improvements)
In consideration ofithe 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, iiabilities 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 gran ted 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 '
Nuevo,Enaineerina" 79-811 Country Club Bermuda Dunes 345-1778
Name of Applicant (please print) Business Address Telephone No.'
Piconi Trucking
Name of Contractor and Job Foreman. Business Address Telephone No.
438834 157 ,r
Contractor's License No., ' City Business License No.
Cal Aa In - CTS 009151.•
Applicant's Insurance'Company Policy Number
FEES: Subdivision ImproVement Permit — Class 111, 0p5i8� S 3'' 06-15-90 i0
10 LASW TOTAL .10.00'
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs "
Minor Improvement Permit _'Cl ass.IV: See attached schedule N2 0721
Inspection Fee $
10.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
0721
PERMIT NO.
DATE APPROVED 6/25[90';` >:
EXPIRATION DATE 6/25/90
DATE ISSUED .6/25/90
By1/.4/!
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 TRIP OVERSIZE LOAD REP4IT
..F
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
r +
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION j;?3 iQ ro4�r��
14'h. 11'lnW 119.138 lbs :HAUL ROUTE: Ave. 52 to
DIMENSION OF INSTALLATION OR REMOVAL
e
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Washington north out of City.
limits
Haul date: June 25, 1990
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
v 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..
a
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 hof Applicant or Agent +
Nuevo Engineering 79-811 Country Club Bermuda Dunes 345-1778
Name of Applicant (please print) Business Address Telephone No.
Piconi,Trucking
Name of Contractor and Job Foreman Business Address Telephone No.
438834 157
Contractor's License No. City Business License No.
Cal AQ In CTS 009151
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III i�005i I 553?6T 0 )5-90 i0.1 f
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
10.00
Permit Fee.
Penalty
Cash Deposit -Surety Bond
if required
1x0.00 '
TOTAL: $
r
Receipt No.
Received by Date
'Recorded by
N2 0721
PERMIT VALIDATION
0721
PERMIT NO.
DATE APPROVED 6/25/90
L*i;1I;1-n-1 yLUL 1IT
6/25/90
DATE ISSUED 0/25/90
By -fes 4h-G-
`� Administrative Authority
TELEPHONE: (619) 564-2246