0812NOTE:
With proper validation E Q"
�O
this form constitutes an CITY OF LA QUI "NTA ; U
encroachment permit #
APPLICATION FOR -PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
FONE 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
Subdivision Im.provement Permit — Class II I
DATE:F. May 1,, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE EQUIPMENT
1
(Street address or Description of.Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Rarhi r rrPP_nQ .
:''10''6" wide.' height and wPjrrht 1nrral HAUL ROUTE: ,BERMUDAS NORTH TO
'AVENUE 52 EAST.TO JEFFERSON TO
DIMENSION OF INSTALLATION OR REMOVAL HIGHWAY 1.11
SIZE OF, .EXCAVATION, IF NEEDED
HAUL PATE: May 1; .1990
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 Quints and to pay for any additional replacement necessary as the result of this work.
Signature VApplicantforfAgent
Massey Sand and Rock PO Box 1767 Indio, CA 92201
Name of"Applicant (please print) Business Address Telephone No.
.Name of -Contractor and Job Foreman: Business Address Telephone No.
on ' file" nn f; 1 c
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 Ifo O
612
Minor Improvement'Permit — Class IV: See attached schedule 7 �i
Inspection Fee - $
Permit Fee 10 . (In
Penalty
Cash Deposit -Surety Bond
if required
$ 10.00
.TOTAL
Receipt No.
Received by _
Date
PERMIT VALIDATION
PERMIT N0. 901113?•�'/� Q n 051'°� -90 a r�'•_nn 4
DATE'APPROVED
EXPIRATION DATE 5/1/9
DATE ISSUED /� " 5/1/90
By .
Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
�%._ . , -•`"}"'z�.s.�:--+.moo*--ter;.•--•...--r. - , ,y"''.,-.--.`°'-- ""..." ✓i..r�....� ... •-.�'..�j:,�.r�-•5....�ti...-�,.��....r.tv..'�.^+F�ww•_' ,.- -fir ,� v-e1yM-..va < "h -a...w
L
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
_>O. `(1�, ONE TRIP OVERSIZE LOAD PERMIT
M 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: May 1, 1990
LOCATION OF CONSTRUCTION MOVE EQUIPMENT
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Harbor Greene
10'6" wide, height and wads t lo>>al HAUL ROUTE: BERMUDAS NORTH TO
AVENUE 52 EAST TO JEFFERSON TO
DIMENSION OF INSTALLATION OR REMOVAL HIGHWAY 111
SIZE OF EXCAVATION, IF NEEDED
HAUL DATE: May 1, 19.90
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 work.
Signature fofdApplicant orAgent
Massey Sand and Rock-' PO Box 1767 Indio, CA 9201
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
on f ile
on fila
Contractor's License No. City Business License No.
on file
Applicant's Insurance Company Policy Number
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
10.00
$ 10.00
Date
0612
PERMIT VALIDATION
PERMIT NO. 005182 01611,2001 p -Qi-90 14
R f1 t'� A\ PlA 4 Yf1 /1) < i It At
DATE APPROVED 5/1/90
EXPIRATION DATE 5/1/90
DATE ISSUED_ / 5/1/90
By
f Administrative Authority
Recorded by 11 TELEPHONE: (619).564-2246
1111111AR 1 -.1 -
NOTE: ,
t. With proper validation 3
this form constitutes an CITY OF' LA QUINTA yI?
encroachment permit
APPLICATION FOR PERMIT_
PUBLIC WORKS CONSTRUCTION '(ENCROACHMENT) y :`
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 -� 4
Y ..
(street address or. Description of Location);_
-
PURPOSE OF CONSTRUCTION' Sketch (attach. -construction plans if appropriate)
DES RIPT ON OF.CDWRUC ION
DIMENSION OF INSTALLATION OR REMOVAL.
SIZE,OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ,
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST .$
(Includinq removal of all obstruction,,, materials, and,debris;.bac!:fi!!ir^„ cern
paction and placing permanent resurfacing -and/or. replacing improvements)
In consideration of the granting of .this' permit the applicant 'he'reby-,,agrees to:
Indemnify; defein' d ,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'prozimate result of, any work undertaken under the permit.granted pursuant, to this application.
t
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 Ouinta and to pay for any-additionalreplacement necessarv,as the result of this work.
i
r., Signature of ApiLrAnt or Agent
DzzName of Applicant'(pl a print) Business Address" Telephone No.
Name of Contractor and Job Foreman, +° Business Address } Telephone No.
Contractor's Vicense No. City.Business icense. N0. -
•:
Applicant's 1 - ranee Company Policy Number
FEES: Subdivision.fmprovement Permit Class III Y i
Public improvements: ,3%of estimated construction costs }
Private improvements: 3% of estimated construction costs N°'
Minor, Improvement Permit -Class. IV: See attached schedule >. +
Inspection Fee $ I PERMIT,VALIDATION r
Permit Fee i
PERMIT NO.
Penalty DATE APPROVED
Cash Deposit -Surety Bond ,
if required EXPIRATION DATE
TOTAL: $ DATE ISSUED
Receipt No. i
By
Received by Date Administrative'Authority
Recorded by 4 TELEPHONE': (619) 564-2246