0919A0
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NOTE:
With proper validation ' 2
this form constitutes an a CITY OF LA QUINTA
encroachment permit
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: Nnveniber 16, 1990 Minor Improvement Permit Class'IV
LOCATION OF CONSTRUCTION move equipment
•
(Street address or Description'of Location) `
barber green paver
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
legal length, weight, 1011011 wide
DESCRIPTION OF CONSTRUCTION NO MOVE ALLOWED BEFORE
7: 00. AM or after ' 5:30 PM
Monday - Friday
DIMENSION OF INSTALLATION OR REMOVAL 8:00 AM Or after 5:00 PM
t Saturday
'
SIZE OF EXCAVATION, IF NEEDED Haul Route; Fred idaring and,
Jefferson St. south to Avenue
APPROXIMATE TIME WHEN WORK WILL BEGIN 50
APPROXIMATE TIME OF COMPLETION Haul date: 11/19/90
ESTIMATED CONSTRUCTION COST $
-(I,ncluding•removal'of all obstruction, materials, and debris, backfilling, co I'm
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.
(Ile 119 /Wfl
re of Applicant or Agent
me of Applicant (please print) Business Address
I
-4050
Telephone No. _
{„Name of, Contractor and Job Foreman ' Business Address Telephone No.
on file on f ile
Contractor's License No: City Business License No. .
on file
j
Applicant's Insurance Company Policy Number
r FEES: Subdivision Improvement Permit,— Class I II
Public improvements: 3% of estimated construction costs p jig2 i g�pb ii 6-g4 10
_Private improvements: 3% of estimated construction costs i a FAR i. � Tf 4f" � 10.00
Minor Improvement Permit — Class IV: See attached schedule +
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10.00 0919
PERMIT NO.
Penalty '
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received' by Date
Recorded by
DATE APPROVED 11/16/90
EXPIRATION DATE 11/19/90
DATE ISSUED 1/16/90.'
By
% Administrative Authority
TELEPHONE: (619) 564-2246
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NOTE:f Y
y Q,
,With proper validation
this form constitutes an
encroachment permit - CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS "CONSTRUCTION (ENCROACHMENT)��
SOF TE18�
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 II I
DATE: 'November 16. 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION mdVe equipment f
(Street address or Description of Location) ,
barber green -paver PURPOSE OF CONSTRUCTION plans if a ppropriate)
Sketch (attach construction
legal lengthy weight, 10' 10`"' wide
DESCRIPTION OF CONSTRUCTION . 1 NO. MOVE ALLOWED BEFORE
7.00 AM or after 5:30 PM r
Monday - Friday'
DIMENSION OFINSTALLATION"OR REMOVAL 8:00 AM or after 5.00 {PM
Saturday .
SIZE OF EXCAVATION„IF NEEDED Haul Route; Fred wring and
' Jefferson -St. south to Avenue
APPROXIMATE TIME WHEN WORK WILL BEGIN - 50
APPROXIMATE TIME OF COMPLETION s�
ESTIMATED CONSTRUCTION COST $ Haul date., 11/19/90 ,
(Including removal of all obstruction,'materials, and debris, backfilling, com- 4'
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. '
�f Signature of Applicant or Agent }'
,<Y�, ,A �nA' 1Pne-le Po Anx 1405 Palm Desert. CA92255-A0 0
Name of Applicant (please print) Business Address Telephone No.
• . , • - i
1, Name of Contractor and Job Foreman s Business Address Telephone No.
on file . _ on file ,
Contractor's License No. - City Busi6ess License No:
an file {
Appl'icant's Insurance Company •. '' Policy Number -
+ FEES: Subdivision Improvement Permit l Class I II
Public improvements: 3% of estimated construction costs 5if3'' �,•-qp iv
Private improvements 3% of estimated construction costs -� 'j�11�. i� 20.00
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee w $ PERMIT VALIDATION,
Permit •Fee 10.00 PERMIT NO. 10919 `
Penalty � •. - .. •� •
Cash Deposit -Surety Bond s DATE APPROVED,'il/16 /90 c'
if required �.r , .11/19/90
EXPIRATION DATE
TOTAL: $ 10.00 .', .'' , .11•/16/90.
{ DATE ISSUED,/
Receipt No.�*
c - N By
Received by Date Administrative Authority i
Recorded by TELEPHONE: (619) 5642246 ti
1 t""r"'4 �3 :.�- :� � •: �. ...� �. �:�- .�... �.. �:.ti�2 �+.. w:� r moi: - �� �� .`ar' L"r:S �r �� �� .�.�, �.: -�
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 '
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
' D CRIPTIOr9 OF CONSTRUCTION
DIMENSION OF INSTAXLATION OR REMOVAL
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-
paction .and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction pians if
7`t
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 (241 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.
Name of Contractor and JJob Foreman Business Address Teleph ne N
Contractor's license _ n City Business License Nd.'
Applicant's Insuradce Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs ''R'',
Private improvements; 3% of estimated construction coots
Minor Improvement Permit — Class IV: See attached schedule t'""
No
Inspection Fee $ }
Permit Fee
Cash Deposit -Surety Bond
if required :..
TOTA6i '
Receipt fro.
I.
RiadlVacl by sate
Recorded by _ ...
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
'r:• EXPIRATION DATE
Aorj lnisteaslve Authfarlty
TELEPHONE; 019) 564,2245