0912• . . NOTE: 4 ,� 2•
With proper validation n 4
O �•
)this form constitutes an
`encroachment ,permit . i CITY. OF '.LA' QUINTA
,. ,.
APPLICATION FOR PERMIT �$
-.'PUBLIC WORKS; CONSTRUCTION (ENCROACHMENT)
ONE' TRIP ,OVERSIZE LOAD PERMIT•
0F
For the"'construction of, public or private , curbs, driveways, pavements, sidewalks, -parking lots, sewers,',water-.mains
,and other. like public works improvements'inlconne'ction with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
-Subdivisiori'Improvement Permit =Class III
NOVEMBER. 14, 1990: - r ,
DATE: Minor Improvement'Permit Class IV.
LOCATION OF CONSTRUCTION move Pcni ix�mPnwt
(Street address or, Description'of Location)
. .
PURPOSE OF CONSTRUCTION barb"ter greene,
Sketch (attach construction plans if appropriate)
'10' 6 wide, ' •legal. height• and •length '
DESCRIPTION;OF CONSTRUCTION green weiaht' Haul ,route: Fred Waring-,and
Adams to Washington to, HWY. 111 -
DIMENSION OF INSTALLATION OR REMOVALHaul date• , 11/14'/9-0 or 11/15/90
'. .
ONE-DAY MOVE ONLY '
SIZE OF EXCAVATION, IF NEEDED
A APPROXIMATE TIME WHEN WORK WILL#BEGIN
APPROXIMATE TIME OF,COMP•LETION
:ESTIMATED CONSTRUCTION COST $
(Including`removal of all obstruct -imaterials,' and debris, backfilling, corn=
paction and 'placing,permanen t,resurfacing and/or replacing improvements) '
In, consideration of the granting of•this•.permit; the al plicant,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 accidant; 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,advarice,of the time,when,work WiWbe 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.
• s Signature of Applicant oi,Agent -
j
Massey Sand ,arid Rock 'h' PO'Box 14050. :Palm Desert, 92255.
Name of Applicant (please print) Business Address Telephone'No.
-Name of Contrictor•and J66 Foreman t ..` .` Business Address Telephone No. c
on' f i1bon ,:file
Contractor's License No. '' City Business Lice_nse'N6.
on file.
Applicant's Insurance Company ;Policy Number {
FEES:-.Subdivision Improvement Permit - Class III " i' 5i8 10 $1_ i i-14-90 11) `
p i fp ASH i TOTAL i V. VV
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit— Class IV: -tiSee attached schedule
Inspection Fee' $'' • ,t' PERMIT VALIDATION .�
.Permit Fee `, 10.'00'0912 "
- y-
PERMIT NO.-' `
Penalty J,
� i `- •� DATE APPROVED ,11/_14/,90 •
Cash Deposit-Surety Bond `. ''t-
if required k:;11/15/90
'EXPIRATION DATE
TOTAL: $ 10'.000
DATE ISSUE17;/.14/90
D
Receipt No:
B
.. Y
Received by Date Administrative Authority.
Recorded by ' , ' 1
} �. TELEPHONE: (619) 564-2246
� e � 1-.YRC w�.EMCjfs�i.�r-f-`.•1�-A a�Ar-••+. -rs•.r. � w. +e. c�.w .i ..��� ro. w o w. �cY w -w. � w., w..c'> .w t'1 RFs: w. w +e.'�t �N Ks 4Y .� l+ .+ rw•.r ?-.u, �A w+ w.•c � r r+ q. �'+ �[', ¢a e:`- �+
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
Oil, TRIP OVERS IkE LORD P` %:,UIT
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: ieOVEI:BER 14, 1990
LOCATION OF CONSTRUCTION mr)irc, e%mi i mmnnt
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION barbcyr greene
101c" wide, l(cral hoivrht and lenoth
DESCRIPTION OF CONSTRUCTION areen iaht
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Haul route: Fred Varing and
Adams to 11ashington to Hwy 111
Haul dates 11/14/90 or 11/15/90
ONE DAY NOVE ONLY
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.
c h��
Signature of Applicant or Agent
i
r
r:as .goy Sand and Rock PO Bo;c 14050 Palm Dosert, �1 92255
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
or_ filo on fila
Contractor's License No. City Business License No.
on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
1 ll d` L 1 Iki.0v
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
$ 10.000
Date
PERMIT NO
a v"
PERMIT VALIDATION
0912
DATE APPROVED 11/14/90
EXPIRATION DATE 11/15/90
DATE ISSUED 11./14/90
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an CITY OF LA CUINTA
encroachment permit v
APPLICATION FOR, PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)' :
OP
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: l / Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
LOCATION. O CONSTRUCTION
(Street address or Description of Location!
PURPOSE OF CONSTRUCTION
DIMENSI&N OF INSTALLATION A REMOVAIv . U
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
7�
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 124) 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 at the.resutt of. this w
Name of Applican;((please print)
Name of Contractor and Jqb oreman
Contractor's Lice s � o.
Signature of Applicant or
Business Address Telephone No.
Business Address le p a No.
City Business Lice se No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III `
Public improvements: 3% of estimated construction costs
Private improvements; 39'0 of oatlmatod conatruotion coots NO
Minor Improvement Permit — Class IV: See attached schedule lel
Inspection Fee $ PERMIT VALIDATION
Permit Fee PERMIT NO.
Penalty
Cash Deposit -Surety Bond
if required ( '•
TOTALI ' '
Ncelpt No..'a'
MAW by data
Recorded by
DATE APPROVED
' EXPIRATION DATE
DATE INU90
By—
�,• A��rrllnlstratly• Authority
TELUNNE; {619) 564.2246