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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)
ONE TRIP OVER SIZE LOAD
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: Att!x 7 s 1 9 An
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION D6 Dozer Haul Route: Washington at 42nd
11'10" width 14 heithh 65 length S/b to 52nd w/b to Bermudas
80,000 weight 'S/b to Nogales and w/b to
DIMENSION OF INSTALLATION OR REMOVAL Navarro
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
i00 5 i COSMO ,6295 AL7 07-90 i' 14
Haul Date:/f8 or 8/9
APPROXIMATE TIME OF COMPLETION One da
ESTIMATED'CONSTRUCTION COST $ HAUL DA E CHANGE TO 9-13-90
(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 oi� Agent
Massey Sand & Rock P.O. Box 1767 Indio, Ca 92202
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 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
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10:00
Receipt No
Received by Date
Recorded by
N' 0770
PERMIT VALIDATION
PERMIT NO. 0770
DATE APPROVED 8/7/90
EXPIRATION DATE 8/9/90
DATE ISS. E,D�L 817,1190
U Administrative Authority
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)
ONE TRIP OVER SIZE LOAD
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
DATfN
=LOCATF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION D6 Dozer
11'10" width 14 hei4ihh 65 length
80,000 weight
DIMENSION OF INSTALLATION OR REMOVAL
Haul Route: Washington at 42nd
s/b to 52nd w/b to Bermudas
s/b to Nogales and w/b to
Navarro
10051 COSMO i6 i0TAL7 %07-Q0 010014
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN Haul Date: '8'/ or ' 8/9
APPROXIMATE TIME OF COMPLETION One dad
ESTIMATED CONSTRUCTION COST $ HAUL DA E CHANGE TO 813-90
(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 & Rock P,O. Box 1767 Indio, Ca 92202
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 ; Policy, Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs o t
��- 07.7
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
Received by _
Recorded by _
$ 10.00
Date
PERMIT VALIDATION
PERMIT NO. 0770
DATE APPROVED 8/7/90
EXPIRATION DATE 8/9/90
DATE IS
S
UED 8/'i7,/90
By
' Administrative Authority
TELEPHONE: (619) 564-2246