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With proper validation
this form constitutes an
encroachment permit CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE DAY OVERSIZE LOAD PERMIT
-For the construction of public or, private curbs, driveways, pavements, sidewalks, parkinglots, sewers, water mains.
and other like public works improvements in connection. with'MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class',lll-
DATE: Aug.. 9, 1990 Minor Improvement Permit.Class IV
LOCATION OF CONSTRUCTION move equipment .;.
(Street address or.Description of Location) '
PURPOSE OF CONSTRUCTION Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION _HAUL ROUTE: SHIELDS rROAD AT
HWY 111 West to.Jefferson, south
to Avenue 52, west approx. 2 1/2
DIMENSION OF INSTALLATION OR, REMOVAL. `48111,13 r ti" miles tornorth of Ave. , 52
1 1 A, �f10
.(Citrus course)
SIZE OF EXCAVATION, IF NEEDED. THIS PERMIT* ISEXTENDED FOR A'
' 'PERIOD •OF _30 DAYS AS OF 8/10/90.
APPROXIMATE TIME WHEN.WORK WILL BEGIN 8/9/90'
HAUL.ROUTE IS.-RESTRIC.ED TO OVE
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)-QLQL-� Ll..l'
In consideration of the granting of this permit, the applicant hereby agr@es 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' stated.
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.
Stgnatdre of Applicant or Agent
Henderson Eauipment 82313 Kenner Avenue Indio,.CA 92201.
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
499568
Contractor's License No. City Business License No.
NorthAmerican IEug JFO' GSP13.8349
Applicant's Insurance Company Policy'Number '
FEES: "Subdivision Improvement Permit — Class. 111 005182 10 6343 08-09-90 10
Public improvements: 3% of estimated construction costs 10 t CASfi 9.. TOTAL, 1. 10<00 y
Private improvements: 3% of estimated construction costs ��T
Minor Improvement Permit — Class IV:`See attached schedule l6 0777
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 1n_na
Receipt No. .
Received by Date
Recorded by
,PERMIT VALIDATION
0777
PERMIT NO.
DATE APPROVED '� 8/9/90 21
EXPIRATION DATE 8/9/90 ;
DATE ISS �J,E-D�-/ 8/9/90
By f
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 DAY OVERSIZE "LOAD PERMIT �'�OF TEiB
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: Aug. 91 1990 Minor ImprovementPermit 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 Stutnnm ster HAUL ROUTE: SHIELDS ROAD AT-' .
' HWY 111 West to -Jefferson; youth
` to,Avenue 32, west-approx.,2 1/2
DIMENSION OF INSTALLATION. OR. REMOVAL 48 1 1.13' F" miles,to north of Ave.'' 52 '
(Citrus' course)
SIZE`OF EXCAVATION, IF NEEDED THIS PERMIT --IS EXTENDED FOR A
y' PERIOD OF So DAYS AS OF 8/10/90.
' APPROXIMATE TIME WHEN WORK.WILL BEGIN 18/9/90
`
HAUL ROUTE ,IS RES RIC ED TO OVE
_ APPROXIMATE TIME OF. COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal•of all obstruction, materials, and debris, backfilling, com s,
paction avid 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 resu t_of this work. i
•ignatu're of Applicant or Agent '
y: -
Henddrson''Equipment 82313.. Kenner' Avenue Indio, CA 92201 '•;
Name of Applicant (please print) Business Address Telephone No. -
• Name of Contractor and Job Foreman Business Address' T Telephone No.
499568 • ' ' ' • . ' ;a��'�'�. .. ,., ..
Contractor's License No. City Business License No.
North American Ins. JFO GSP13�8349
Applicant's Insurance Company Policy Number.
FEES: Subdivision Improvement Permit — Class III' .005182 0, 6343' 08-09-90 10
0 CAS -
r'
1 ' S, TOTAL
i0:00
f
H
n
Public Improvements: 3% of estimated construction costs _” !? . • •
Private improvements:_ 3% of estimated construction costs IV!o ;
Minor' Improvement Permit — Class IV: See attached schedule 0777
Inspection Fee $ II PERMIT VALIDATION ,
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
10.00
TOTAL: $ 10, 00
Receipt'No.
Received by Date `
Recorded by '
iJ� � iyF�r71�fl�it5: . .
t
' •
PERMIT NO. •0777
DATE APPROVED '8/9/90
,. EXPIRAT_ ION DATE
8/9/90' '
/- 8/9/90, _
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246' r
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INSURANCE IDENTIFICATION CARD
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(STATE)
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COMPANY NUMBER
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POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE •y ! Ij
349.:
1 8 09/01/89
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TSA MAKE/MODEL
_ VEHICLE
I a 1 NUMBER
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INT' L T ACTOR • 3804 " a. •;, 1 ',w.
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J AGENCY/COMPANY ISSUING CARD.,
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North American Insurance Agcy
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714-771-7400
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INSURED
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Henderson?Equip Sales.-inc'
'
s 82-313 Kenner Ave
=�
92201
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,; SEE IMPORTANT NOTICE ON .REVERSE SIDE.
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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)
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: Minor Improvement Permit Class iv
LOCATION OF CONSTRUCTION '
IStreet address or Description of Location) '
r s
PURPOSE OF CONSTRUCTION' Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
- DIMENSION OF INSTALLATION ORREMOVAL • 0�?G�'� Cf� f -
•;
F 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-
p
paction andlacin g permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to: t:
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 Quina and to -pay for any additional replacement necessaryes the result.of this work:
Z.
Signature of.Applicant or Agent
Name of Applicant (please print) *. Business Address Telephone No.
Name of Contractor and .lob Foreman Business Address "� Telephone No.
Contractor's License No. City Business License No.
f 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
Minor Improvement Permit — Class IV: See attached schedule *'
inspection Fee S II PERMIT VALIDATION'
Permit Fee I
PERMIT NO.
Penalty DATE APPROVED -
Cash Deposit -Surety Bond
if required EXPIRATION DATE
TOTAL: $ DATE ISSUED '' r
Receipt No. x
Received by Date Administrative Authority
Recorded by - f TELEPHONE: (619) 5642246- '