0837•, '.�
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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 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 Improvement Permit — Class I II
DATE: September 21, 1990 Minor Improvement Permit Class IV
LOCATION OF -CONSTRUCTION move equipment
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION - -225 CAt track hoe
121. wide. leaal height 106,000
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL'BEGIN
Sketch (attach construction plans if appropriate)
Haul Route: Ave. 50 and Washington
west to Eisenhower, north -to
Ave. Fernando,
Haul Hatt: -9/21/90
APPROXIMAT&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 ofthe 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
C Sid�aJ1ture of Applicant or Agent.
Piconi,Trucking 39723 Old'Carriage Rd. Marrietta, CA 714-677-8196
Name of Applicant (please print) `. y Business Address Telephone No.
Name of Contractor and Job Foreman - Business Aadress Telephone No.
ori file on.file
Contractor's License No. City Business License No.
on file. Cal Ag.
Appl'icant's Insurance Company Policy Number
FEES:
Subdivision`lmprovement 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:
10.00
t
$ 10.00
Receipt No.
Received by Date
Recorded by
000 i 8iSH i TA i -90 10.00 0
N° 0837
PERMIT VALIDATION
PERMIT NO. 0837 -
DATE APPROVED 9/21/90
EXPIRATION DATE 9/21/90
DATE ISSUED 9/.21/90
By
Administrative Authority
TELEPHONE: (619) 564-2246
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NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATIONFOR 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
September 21 , 1990 Subdivision Improvement Permit - Class I II
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION move equipment
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 225 CAt track hoe Sketch (attach construction plans if appropriate)
12' wide. leaal heiaht 106.000
DESCRIPTION OF CONSTRUCTION
Haul Route: Ave. 50.and Washington',
west to Eisenhower, north to
DIMENSION OF INSTALLATION OR REMOVAL Ave. Fernando
SIZE OF EXCAVATION, IF NEEDED
Haul Rete: 9/21/90
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) 'hoursin 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. _
`--Sarrla1ture of Applicant or Agent
Piconi Trucking 39723 0:.garriage Rd. Marrietta, dA•714-677-8196
1 .• Name.of Applicant (please print) `��' Business Address Telephone No.
Name of Contractor and Job. Foreman Business Address Telephone No.
oxi file on file
Contractor's License No. City Business License No.
on file Cal Ag.,.
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:' $ 10.00
Receipt No.
Received by Date -
Recorded.by
d0o" ' iAS% � TAL 2i -90 S4, Ot�0
2 0837
PERMIT VALIDATION
PERMIT NO. 0837
DATE APPROVED 9/21/90
EXPIRATION DATE 9/21/90,
DATE ISSUED _ 9/21/90
By��%.
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper:validationt
this form constitutes -an -
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC- WORKS'- CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements; sidewalks, parking lots, sewers; water�nwimo,,
and other like public works improvements in connection with -MINOR IMPROVEMENTS and APPROVED SUBDIVISIONSw`
Subdivision Improvement Permit — Class Ill
DATE: / �� - Minor i improvement Permit Class IV ;
LOCATION OF CONSTRUCTION _7Gi2:__
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION A/c` Sketch (attach construction plans if appropriate)tt,
DESCRIPTION OF CONSTRUCTION �''QT �-�'��,�h °`L �9v� �� /� " " i�SJJ✓9�U4 "
a./ Q,G rfT O G✓t? ST $'1„h/ hQ►^/�.i`V// 7�l
DIMENSION OF INSTALLATION OR REMOVAL _rC) 7Z9f1®91'1010 L✓2s7 i d fJOZ
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK"WILL BEGIN
APPROXIMATE TIME OF COMPLETION +
ESTIMATED CONSTRUCTION COST $
(Including removal of ail obstruction, materials, and debris, bad+tfilling, 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 i nd�sW
penalties, tiabilities or loss resulting from. claims or court action and arising out of any accident. loss or damage -to persons' or praperty�
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 (241 hours in advance of the time when work will be started.
Comoly 'with all applicable -City Ordinances, the terms and conditions°of the permit and all applicable rules and regulations of th@ COty of
La Cuinta and to pay for any additional replacement necesesm,as theIt�of this work.�j ,
' Sig ure of Applicant or Agent
i bi✓i Z/1 r✓ 3 S 6&
77 S�
Name of Applicant (please print) Business Address /Y Telephone No.
Name of Contractor and Job Foreman
Contractor's License No.
Applicant's InsulanlEe Company
FEES: Subdivision Improvement Permit —Class Ill
Business Address
Public improvements: 3% of estimated construction cost
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection l=ee S
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Telephone No.
City Business License No.
Policy Number
• N°
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
$ II DATE ISSUED
Received by Date
Recorded by M
By
Administrative Authority
TELEPHONE: (619) 5642246=