1000a
•
I
`
NOTE:
With proper validation•
'
••this.form constitutes an
CITY -OF LA QUINTA_
encroachment permit' .. J�
APPLICATION ' PERMIT 80-
,FOR
•,. WORKS CONSTRUCTION (ENCROACHMENT) �� I•.�pSww�
;.
,PUBLIC,
;• 0F
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:lm'provement Permit — Class III'
February 6,. 1991 -_•
,
DATE: Minor'Improvement.Permit Class IV
LOCATIONmove equipment
OF CONSTRUCTION •
(Street address or'bescription of Location)
P.URPOSE.OF:CONSTRUCTION move eauinment ," Sketch (attach construction plans 'if appropriate)
DESCRIPTION OF CONSTRUCTION stunmastAr' l Haul Route -i' Aveniie 50 and Jefferson
•
' west`. 1/2 • mile
DIMENSION_(OF INSTALLATION OR REMOVAL�1V0 w: '48'1 lone:
`
115.300 lba' .' .:
SIZE OF EXCAVATION, IF,NEEDED
01
t
TIME�WHEN WORK WILL BE6IN,2`/6/91 Haul"dates 2/6'/91 and"2/7/91.
,APPROXIMATE
•
••" .APPROXIMATE TIME OF COMPLETION". r: ". `
-ESTIMATED CONSTRUCTION COST $
�+
, .
(Including removal.of all obstruction, miter•ials,'and debris, backfilling, coni �{ `
, . t .: �' r p .tip•; .'- "
-aft
paction and placing permanent.resurfacing and/or. replacing improvements)
•'
-
Inconsideration ,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 `
`r ,
r .• .t La Quinta and 'to'pay ,for any.additional replacement necessary as the result—of this work. -e-
r'.Signature of•Applica'nt or�A•gent
..
t�Henderson Equivment 182313 Kenner Indio', CA92201
Name of Applicant (please print) r` `' Business Address 1, • •' Telephone No
:
*�
'
`
• Name of Contractor and,Job.Forem'an • , . ':.• Business Address r, " ..'. i;t Telephone No:
"`499568 '- T*. •; .' t r' .'. t �' �'� ►. 1073 ",
1
•
"
Contractor's License'No. •' ` " r City'Business License No.
North American Insurance ''-j jJFP• GSPLl_38349.+
'
Applicant's Insurance Company - '` t: 'Policy Number,
I
_ ,
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FEES: Subdivision Improvement Permit — Class'I II
Al
o Y ".. • A , ,v, p(�5i8 989q .1-06-9 ii0
Public improvements:.3./0 of estimated construction costs , i0.• ASH f -Ti AL i 90•�Ot7
w .•,,
Private improvements: 3% of estimated construction costs ` • =
Minor Improvement Permit - Class IV: See attached schedule'
•
� • r • - '
•,
Inspection Feet .� $ -
p PERMIT tiVALIDATION
Permit Fee 10:; 00 • ' r" r t. ' 1
` PERMIT NO. onn - '
Penalty . - .. ` , . ..
Cash Deposit -Surety Bond. DATE APPROVED 2.6/91 '
if required EXPIRATION DATE
TOTAL: $ •1 n _ nA 2691 •'
• • DATE ISSUED --� / /
Receipt No.
Received by Date
Recorded by
�r
BY'�7y
. Administrative Authority
TELEPHONE: (619) 564-2246
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NOTE-`
With proper validation
this form constitutes an
encroachment permit
CITY OF LA OUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
f
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 .
February 6, 1991' Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV '
LOCATION OF CONSTRUCTION move equipment
(Street address or Description of Location) ,
PURPOSE OF CONSTRUCTION move ecluinment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION stunmaster Haul Routes Avenue 50 and Jefferson.,
west 1/2 mile'
DIMENSION OF INSTALLATION OR REMOVAL 11'6" w., 4811 long
115.300 lbs?
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 2/6/91 Haul dates: 2/6/91 and 2/7/91
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
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.
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 resul.t•.of this work. ;
Signature of Applicant orgent
�enderson Equipment 82313 Kenner Indio, CA 92201 Y:
Name of Applicant (please print) Business Address Telephone No. '
Name of Contractor, and Job Foreman Business Address Telephone No.
499568 1073
Contractor's License No. City Business License No.
North American Insurance JFP GSPL138349
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
j
PERMIT VALIDATION
PERMIT NO. 1000
DATE APPROVED 2/6/91
EXPIRATION DATE 2/7/91
tPATE ISSUED -� >' 2/6/91
.17
ByL
'Administrative Authority
TELEPHONE: (619) 564-2246