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this form constitutes an
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CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
t1'?
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
y
DATE:
LOCATION OF CONSTRUCTION T'low EQM
Subdivision Improvement Permit— Class Ill
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE BARBER GRM Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 10'V WIDE HEIM ZEAL
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
HAUL, ROUpTEg�
_ 2D
AS,NORTH ON
BAS %xT00 WASHINGTON
WASHINGTON NORTH OUT OF CITY LIMITS
DATE 6-4-90 or 6-5-90
ONE DA19NLY
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 resulp�of this work. I
v Signature of Applicant or Agent
M
ASSEY SAND AND ROCK P.O.BOX 1776 INDIO CA 92202
Name of Applicant (please print) Business Address 005182 tTifel,ephong-No-90 !4
i0 CASi� i �IOT�L i io.00
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE ON FIEF
Contractor's License No. City Business License No.
App l`icant''s•Insu ance Company Policy Number
FEES: Subdivision Improvement Permit —Class Ill
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 3a
Minor Improvement Permit — Class IV: See attached schedule�� J
Q
Inspection Fee $ PERMIT VALIDATION
Permit Fee ' 01,00 PERMIT NO.
Penalty
Cash Deposit -Surety Bond DATE. APPROVED ll /'; %
if required D EXPIRATION DATE /n� LI s i) t ',��t_(S
TOTAL: $ I
DATE
Receipt No. i
BY .-..
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
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- y
NOTE: _
With proper validation 00'h
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
Subdivision Improvement Permit .-.Class III
DATE:Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 1115M MUZ R M
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 1'12%11 EMP71 GRM Sketch (attach construction plans It appropriate)
DESCRIPTION OF CONSTRUCTION 10'6" WIDE GH LWAI
E RM
BES iU�AS ATO 52DTO WASAS HINGTON
DIMENSION OF INSTALLATION OR REMOVAL WASHINGTON NORTH OUT OF CITY LIMITS
DATE 6-9-90 or G-5-90
SIZE OF EXCAVATION, IF NEEDED ONE DAONLY
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 (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 resulVof this work.
Signature of Applicant or Agent
DRSSEY SAND AND ROCR P.O.BOX 1776 INDIO CA 92202
Name of Applicant (please print) Business Address 00131/92 �T�elephone�No>4?0 14
L0 C; fi i YOE i 0 150
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE ON
Contractor's License No. City Business License No.
ary ri h� iJ
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 10, 00
to 00
Received by Date
PERMIT VALIDATION
PERMIT NO. r
DATE APPROVED r
EXPIRATION DATE
O'4TE ISSUED
o
Administrative Authority
Recorded by II TELEPHONE: (619) 564-2246
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NOTE:
With proper validation
this form constitutes an
encroachment permit
-------------- --- 7—
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
Subdivision Improvement Permit— Class III.
DATE: A-4-90 - Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION MOVE EQUIPMENT:.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE BARBER GREEN Sketch.(attach construction plans if appropriate).
DESCRIPTION OF CONSTRUCTION 10'6" WIDE HEIGHT LEGAL.:
HAUL ROUTE
CpLI �p BE RMUDAS NORTH. ON
BERMUDAS '�O'" 52 TO WASHINGTON
DIMENSION OF INSTACLATION:OR REMOVAL WASHINGTON NORTH. OUT. OF CITY LIMITS
1
SIZE OF EXCAVATION, IF NEEDED DATE: 6-4-90 .ox.- 6-5-90
ONE DAQNLY
APPROXIMATE TIME WHEN WORK WILL BEGIN
4
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)
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
La Quinta and to pay for any additional replacement necessary as the.result of this work.
Signature of Applicant or Agent
AIASSEY SAND AND ROCK P.O.BOX 1776 INDIO CA 92202
Name of Applicant (please print) Business Address 005182 � O -T8�h06 -U4-90 14
10 CA H i TOTAL i i0.00
Name of Contractor and Job Foreman Business Address Telephone No. -
ON FILE ON, FILE
Contractor's License No. City Business License No.
Applicants nsurance 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 t O
Penalty
Cash Deposit -Surety Bond
if required
� X00
TOTAL: $
Receipt No.
Received by Date
Recorded by
N2
PERMIT NO. !
DATE APPROVED IQ q_E
EXPIRATION,DATE - L
AT ISS U _
By
PERMIT VALIDATION
TELEPHONE: (619) 564-2246
Haminisirauve Huinoriiy