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0851
• AIF NOTE:` With proper validation `F 4 2� O this form constitutes an ^ y ..CITY' OF LA QUINTA t, encroachment permit- , r .�; `APPLICATION FOR PERMIT _ $ A PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) ONE '.TRIP.`OVRRSIZE LOAD PERMIT oFT�� , 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 October 2•,y 1990 Subdivision,lmprovement Permit —= Class II I DATE: Minor Improvement Permit Class_ IV LOCATION.OF CONSTRUCTION' move.` equipment71 ' t (Street address or Description of -Location-) r ' PURPOSE OF CONSTRUCTION" 9$0' loader. Sketch (attach construction plans if appropriate)' h.•12 ° w-=12.1 43, 0000 •olb ' DESCRIPTIONOF.CONSTRUCTION' �' r• r 50UTA ON 'WASHINGTON TO. . EISENHOWER WEST TO: : '. 'FERNANDO .. DIMENSION OF INSTALLATION'.OR•REMOVAL - ' - HALL .DATE: SIZE OF'EXCAVATION, IF,NEEDED ' APPROXIMATE TIME WHEN WORK W.ILL*BEGIN { ? APPROXIMATETIME'OF, COMPLETION ESTIMATED CONSTRUCTION COST $ J - • , �� I .(Including 'removal of�alI 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,staried: ' Comply with all applicable City Ordinances, the terms and conditions, of the permit and all applicable rules and reguIations'of the City of 'La, Quinta and to, Pay for any, additional`replacement necessaryas the result of this work. , s TSignature of Applicant or Agent'. ri , i ,;,. n1.1, '� R (1 Rnlii ti PA PA 1 m nogprf- CA i Name of Applicant (please print) 'Business Address Telephone No. .. ' John' 'Piconi Trucking" i Name of Contractor, and Job Foreman Business Address Telephone -No. -ori file A r' _ on file, Contractor's'License No.' ; - City Business.License No. <:on file , Applicant's Insurance Company =� Policy Number FEES': Subdivision.I'm proGement Permit =_Class IIIA 33� 0- 2-90 - 10 Public improvements: 3% of estimated construction costs �Af°I 70'r L `� 10.00 , Private, improvements: 3% of estimated construction costs T Minor Improvement Permit -`Class IV: Se'e'attached schedule , '� N2 ' ® 8 5 1- .; Inspection Fee $ PERMIT VALIDATION Permit Fee .1.0.00 0851. PERMIT NO: -Penalty Cash -Deposit Surety Bond DATE APPROVED if required EXPIRATION DATE 10/2./90 , TOTAL: $ 10.`00 10/2/90 DATE ISSUED Receipt No. B' .6`TIlJ i5•.s Y. ' Received by Date ; ./Administrative Authority Recorded by TELEPHONE: (6191 564'2246 r - - - r w r - - - w w r r w a -- - r r r w I.. w-...- - -- r - w - w - I NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) ONE 'TRIP OVRRSIZL 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 October 2, 1990 Subdivision Improvement Permit —Class II I DATE: Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION move equinment (Street address or Description of Location) PURPOSE OF CONSTRUCTION 9$0 loader h 12' w-12' 43,000o olb 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) SOUTH ON WASHINGTON TO EISENHOWER WEST TO FER14ANDO WWL DRTE: 10/2/90 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. � r Signature of Applicant or Agent 77 rRn Rn'hin Rd P -.0-M Lgm?,P_rt. C.A. Name of Applicant (please print) Business Address Telephone No. John Piconi TZrUckinq Name of Contractor and Job Foreman Business Address Telephone No. on file Contractor's License No. on file 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 Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ Permit Fee 1G. 00 Penalty Cash Deposit -Surety Bond if required TOTAL Receipt No. Received by Recorded by _ $ 1.00 Date PERMIT NO 4ift)'fF�I.12" iU. " PERMIT VALIDATION 0851 DATE APPROVED 10,/2./90 EXPIRATION DATE 10/2/90 DATE ISSUED. 10/2/90 By s 'Administrative Authority TELEPHONE: (619) 564-2246 NOTE: With propervaiidation r. this form constitutes an encroachment permit A 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; waterrRginisg,.:. and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS2` ' Subdivision Improvement Permit— Class ill �•, DATE: OC a I Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION. (Street address or Oes ription of Locationla T P RPOSE OF CONSTRUCTION �g0 Go�r2"' Sketch•(attach construction plans if appropriliftl*:11. -/ ZY7 42 ' GUI 04f,-) 777 . v5 h � � DESCRIPTION OF CONSTRUCTION, - DIMENSION OF INSTALLATION OR REMOVAL C5� � 7 SIZE OF EXCAVATION, IF NEEDED v APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST$ T (Including removal of all obstruction;'materials, and debris, bad*filling, 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 end all penalties. liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage -to persons or propeRy^ happening or occurring as a proximate result of any work'undartaken 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 appOcable-ruies and regulations of the City of La Quint& and to pay for any additional replacement•necessary:as the remit of this work. me of Applicant (please print) • Signature i� tura of Appli nt o Agent �6 Business Address Telephone No. Name of Contractor and Job Foreman Business Address , ' Telephone No. Contractor's License No. City -Business License No. Applicant's Insurance Company Policy Number v FEES: Subdivision Improvement Permit —Class 111 Public improvements: 3%of,estimated construction costs Private improvements: 3% of estimated construction costs 0 Minor Imorovement Permit — Class IV: See attached schedule a Insoectlon Fee ' S Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL. ' $ Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO., II DATE APPROVED EXPIRATION DATE DATE ISSUED By Ad m i n i strat ive' Auth or ity TELEPHONE: (6191564.224& WALTONS BACKHOE SERVICE 3-90 3240 77580 ROBIN ROAD PH, 619-345-5212 PALM DESERT, CA 92260 90-7035/3222 19 9 PAY TOTHE } .�qJ//ate�,..- a. .......� 4& ORDER OF $ ! oGV� DOLLARS © DoWNEY SAVINGS - LOM, INDIOOFFICE - - "' 01020HIGHWAY111 ,, •/(f//�////�- _ + IND{O. CA 92202 FOR 20.03 240II'.-- 1:3-2 2 27,0356,:556000 1993,16