1001 (2)�-:.;2f pT�+h,,v f-.•3Pfy `r f c�.a {, '.'y." •., -,,y '' � + �- .4y � -" •., - Y- r -•.> '-. •.. • -,� •`-•
.i a4"y-'t - ,>: >'J -LCL Wd • u ,i.��•v, s t ,"'• .-.1 '� ' .•m-'i,�.1 .....'—.,.�.+...,.j, ��i.�,: .; R-,
NOTE:
With proper "validation
this form -constitutes an CITY OF LA QUINTA
l / 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
�. :rte %• - ' ` Subdivision Improvement Permit — Class III
February;. 6,. 1991.: "
DATE:' _ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION,—move,'equipmint
(Street address or. Description"of Location)'
' . PURPOSE'OF CONSTRUCTION.` Sketch (attach construction• plans if appropriate).
` stumumaster' Haul Route: Avenue 50 to Jefferson
,� DESCRIPTION OF:CONSTRUCTION,• ,
•' -�1L .Yi `S` "• • - ' "� ••west on Jefferson 1/2 mile •-'
IMENSION,OIF INSTALLATION OR REMOVA1Ll'w. 48•16ni Haul date: 2/6/91 and 2/7/91
t 11.5 ! 300 :`lbs ;.
=SIZE OF EXCAVATION; I,F NEEDED'' '
y APPROXIMATE TIME WHEN WORK WILL' BEGIN.",
../APPR'OXIMATE TIME OFaCOMPLETION",-
ESTIMATED CONSTRUCTION COST.
'•,(Including removal of.all obstruction, materials; and debris, backfilling, coin
paction and placing permanent'resurfacing',and/or replacing improvements) `
In'consideration,of the granting of this permit, the applicant'hereby agrees
'to'.
%,y • :Indemnify;-defend'and save•the City,°it0adthorized�agerits, officers, representative"s and employees, harmless from and against any .and all
perialties; liabilities or loss resulting from claims'.or court action and arising out of any accident, loss or damage •to persons or property
�.• w.,. -, u. ,
'happening or,occufring:,asla'proximate result. of any 'workyundertaken under 4he,permit granted pursuant to this application.-.
Notify the Adrninistrative�Authority at."least,twenty-four (24) hours in,`advance of the time when work will be started.,
?r
r
' { `
'Comply with* all applicable'City Ordinances„the terms and conditions 'of"the permit'and all applicable rules and regulations of,the City^of.
rr La Quinta and to pay for. any additional `replacement,necessary'as the result of this work
jo—
Signature'of Applicaant or Agent
Ice-
,
s� • . Henderson .Equipme t �k' 82333 Renner Indio, CA' ^ 92201
Name of 'Applicant.(please print) ;•`. F' �' 'Business Address."Telephone No.
Name of,Contractor and Job Foreman Business Address f i- Telephone No.'
499568_. r 1073
Contracto'r,'s License Nod City Business License No.
North American 'insurance �.• JFP GS12138349
Applicant's Insurance Company : :'. Policy Number
FEES: Subdivision Improvement Permit — Class III.
pQ�Si.B -9-91
Public improvements: 3% of estimated construction. costs
Private -improvements: 3/0 of estimated construction costs ,
Minor Improvement Permit — Class IV: See attached schedule
!
'Inspection Fee $ ` �� PERMIT VALIDATION
Permit Fee 10.00
Penalty;. .k.
Cash Deposit -Surety Bond ;
if;required
TOTAL: $ 10_nn {'
Receipt No.
Received by Date
Recorded by
.PERMIT NO. 1�n1
DATE APPROVED, 2/691
EXPIRATION DATE 2/7/91
DATE ISSUED 2/6/91
By
Administrative Authority
TELEPHANE:'(619) 5642246"
t
M
:F
w
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
DATE: February 6. 1991
LOCATION OF CONSTRUCTION move equipment
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION stumpmaster Haul Route: Avenue 50 to Jefferson
west on Jefferson 1/2 mile
DIMENSION OF INSTALLATION OR REMOVA111w. 48 lone Haul date: 2/6/91 and 2/7/91
115,300 lbs
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)
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 theCity, of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Signure of Applic t or Agent
Henderson Equipment 82333 Renner Indio, CA 92201
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 GS1e 138349 ,
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 $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
10.00
f
s
$ 10.00
Date '
005is" 10 AW tyb9b P 87 oib�91 i0. X
PERMIT VALIDATION
PERMIT NO. 1001
DATE APPROVED 2/6/91
EXPIRATION DATE 2/7/91
DATE ISSUED,,- 2/6/91
By
"., Administrative Authority
TELEPHONE: (619) 564-2246