0941 (2)NOTE:
With proper validation '
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE LOAD PERMIT
i
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: November 29, 1990
LOCATION OF CONSTRUCTION move equipment
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
(Street address or 'Description of Location)
PURPOSE OF CONSTRUCTION. 966 loader. Sketch (attach construction plans if appropriate)
15' hi«h. 10'twide.-lnaal lenath am cat Hain route: Nogales to Navarro
DESCRIPTION OF CONSTRUCTION to Bermudas to Ave. 52 to
Washington to out of.City limits
DIMENSION OF INSTALLATION OR REMOVAL no move before 7 . am or after
5:30 pm Monday -Friday
SIZE OF EXCAVATION, IF NEEDED Saturdays $-5 only
Haul date: 11/29/90
APPROXIMATE TIME WHEN WORK WILL BEGIN
• 1
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $' 005i8.'' ?I 8400 11-29-90 10
(Including removal 'of all obstruction, materials, and debris, backfilling, com- i0 LASH i T01'AL i i0.00
paction land 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.
, 1. � / psi � ✓/ // _ _ A
Signature of Applicant or
.Tarmac/Massey PO Box 14050.Palm Desert, CA 92255
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.
s.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs q
Private improvements: 3% of estimated construction costs A,T2 d
Minor Improvement Permit — Class IV: See attached schedule A
Inspection Fee $
Permit Fee _
Penalty _
Cash Deposit -Surety Bond
if required _
TOTAL
Receipt No.
10.00
$ 1n -nn
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.' 0941
DATE APPROVED 11/29/90
EXPIRATION DATE 11/29/90
DATE ISSUED / 11/29/90
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
APPLICATION FOR PERMIT
I
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
1
s
DATE
November 29, 1990
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION move equipment
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 966 7 oader Sketch (attach construction plans if appropriate)
15' high. 101wide. leaal lenath am wt Haul route: Nogales to Navarro
DESCRIPTION OF CONSTRUCTION to Bermudas to Ave. 52 to
Washington to out of City limits
DIMENSION OF INSTALLATION OR REMOVAL no move before 7 am or after
5:30 pm Monday -Friday
SIZE OF EXCAVATION, IF NEEDED Saturdays 8-5 only
Haul date: 11/29/90
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 0051821�Q 8401 11,-29-'90 W
(Including removal of all obstruction, materials, and debris, backfilling, com- 0 CA. IH OTAL i 040
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.
Signature of Applicant or Agent
Tarmac/Massey PO Box 14050 Palm Desert, CA 92255-4050
Name of Applicant (please print) Business Address f
Telephone No
Name of Contractor and Job Foreman Business Address Telephone No.
on f ile on file
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
10.00
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by
Recorded by
Date
PERMIT VALIDATION
PERMIT NO. 0941
DATE APPROVED 11/29/90
EXPIRATION DATE 11/29/90
DATE ISSUED 11/29/90
Byr
Administrative Authority
TELEPHONE: (619) 564-2246
AOL
—F — -- -- -- —
NOTE:
With proper validation.
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 mains
and other like public works improvements in connection with MINOR. IMPROVEMENTS and APPROVED SUBDIVISIONS
f` �jAFLO
Subdivision Improvement Permit —Class III
DATE: / !Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
{
Aa- V ,
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 Guinta and to pay for any additional replacement necessary, as the, result of, this work.
Name of Applicant (pgase print) Business Address Telephone No.
Name of Contractor a d Job Foreman Business Address Telephone No.
Contractor's License No.� City Business, License No.
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 costae
Minor Improvement Permlt — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Gash Deposit -Surety Bond
if required
TOTALi' t..
Nceipt too••
Nablail by - - bete- -- -
Recorded by
N?
PERMIT VALIDATION
PERMIT, NO.
DATE APPROVED
EXPIRATION DATE
®ITE I55UIB __
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TELEPH09; (519) 504,2240