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NOTE:. ' - '
With proper validation
this.form constitutes an,,CITY. OF LA QUINTA
encroachment permit
APPLICATION FOR- PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE MPTP OVERSIZE LOAB 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 III
DATE:' 11-19-90 Minor Improvement Permit Class IV,
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Can ,- gC;.;.o Haul Route.. 52nd & .Jefferson
10' wide legal heictht andk ength' to Bermudas to Nogales
green weight
DIMENSION.OF INSTALLATION OR REMOVAL
Haul Date.. 11-19-90
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-
pactionand 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,, off icers,'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.
i- 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.
ti Signature of Applicant or Agent .
Ma$sey Sand & Rock P.O. Box 14050 Palm Desert, Ca 2255,-4050
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address. Telephone No..
On file on file
' Contractor's License No. City Business License No.
on fi7,e
j' Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
y . Public improvements: 3% of estimated construction costs �?Q5i0 0 82 it -0-90.-
iv
Private improvements: 3% of estimated, construction costs 1�1 A H i TA. iM-00
Minor Improvement Permit — Class IV: See attached schedule 0 �0) 2
Inspection Fee, $
Permit Fee �D 00
Penalty '
Cash Deposit -Surety Bond'
if required
TOTAL: $
Receipt No.
Received by
Recorded by
1
Date
PERMIT VALIDATION
PERMIT NO. Z
DATE APPROVED h
EXPIRATION DATE /H 7
DATE ISSUED _ 0 q 0
By:-- � W,� �Sl/
Administrative Authority
TELEPHONE: (619) 564-2246
n
o.
M?'eiwiY:'K y- eN-�ir.i .e ...� `.; ! tr••rN�C: +w -a .!w.w !r'a7+•w rq-tea., .�.>.,�.. .a-l�i..4._.3'a..r .«. w.c R. `w. _..rK — a.. r, ..c w.•. ... 4
NOTE:
With'proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION -FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSTZE LOA= PERMIT
For theconstruction 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 I
DATE: 11•-19-90 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch .(attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION -� �e� —b rn-cbI.ngm Haul Rowe.. 52nd & Jefferson.
1a' wide fecal height and lencith to Bermudas to Nogales
areen weight
DIMENSION OF INSTALLATION OR REMOVAL
y
Haul, Date.. 11-19-90
SIZE OF EXCAVATION, IF -NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME'OF COMPLETION
ESTIMATED CONSTRUCTION COST $
I
(including removaFof all obstruction, materials, and debris' backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
it
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 '
I¢ 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.
r -
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 f this work.
Signature of Applicant or Agent
Massey .$and .&Rock P.O. Box 14050 Palm Desert, Ca 255-050
'r Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
on file on file
Contractor's L'icen'se No. City Business License No.
on. file
Appl'icant's Insurance Company Policy Number
FEES:. Subdivision Improvement Permit — Class l II
Public improvements: 3% of estimated construction costs�i,(3'�,Qp�� ig f9 -9Q
j r Private improvements: 3% of estimated construction costs 1A3N 1 TOTAL 10'. 00
Minor Improvement Permit— Class IV: See attached schedule 09
Inspection Fee $
Permit Fee //9,00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ Z 0• 0
Receipt No
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. g 2
DATE APPROVED �" ) q " Q
EXPIRATION DATE H-19 ~ 9
DATE ISSUED "' a _ Ci o
ByT 7d1
/Administrative Authority•'.
TELEPHONE: (619) 564-2246
NOTE. i ({
With proper valldatloit
this form constitutes an ; . = , . `'�
encroachment permit CITY:,OFt, LA :QUINTA
APPLICATION ;"FOR; PERMIT ® _
PUBLIC WORKS CONSTRUCTION (ENCROACHMMIIT) '
op
For the construction of public or. -private curbs, ; driveways,' pavements, sidewalks, parking lots, sewers, water twins • `
and other like public works Improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Ila Subdivision Improvement Permit— Clas
S III '
DATE: / j �(f ' '<z=;. ;' : Minor Improvement Permit Class. IV'
LOCATION OF CONSTRUCTION
r
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION ' Sketch (attach construction plans if appropriate)
DESCRIPTINOF CONSTRUCTION -
. .
DIMENSI N OF INSTA LATION OR REMOVAL ✓�
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN }= *r r
APPROXIMATE TIME OF COMPLETION /L
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials,,and debris, backfilling, com l_
, 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,Clty, 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 env 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 of Applicant or A ant
Name of Applicar/(please print)
Business Address Telephone No.
Name of Contractor and Job Foreman
Business Address' Telephone No.
4"t � $
_Contractor's L' ansa No.
' M t - City Business Lice a No...,
Applicant's lnsu ance Company
Policy Number '
FEES:. Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction
costs
.::. .
Private Improvements; 3% of estimated construction coinsNo
Minor Improvement Permit --Class IV: See attached schedule'': •'
Inspection Fee $ '
L.; .r�'ti
`• �� PERMIT VALIDATION
Permit Fee -
s PERMIT N0,
Panelcy'tc
r ,i+
t
Cash Deposit -Surety Bond
w t= ,
+ DATE APPROVED
,
if required s
EXPIRATION DATE
'DATI
y,F rs,.....•
IN=
_
Ncelpt No..
r
gy °...:..:. ..._-' ..
Aer&e8 6V bete
:'
Adinihittrative Auth®flty
Recorded by ` .
_ °_ �;
TEERHS?NE; (519) 564,2246