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+`� - .NOTE: „ � "° ,. - .. .. ••' • ,. - . ' • ..
With'.proper validation r•. ,
this form constitutes an L'
encroachment
- ' CITY --OF :LA QUINTA
permit
APPLICATION FOR PERMIT '
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OVERSIZE.LOAD PERMIT OFT
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 ,19; 1991.Subdivision Improvement Permit — Class III' "
' DATE: , Minor Improvement. Permit Class IV
LOCATION OF CONSTRUCTION. moire an11 i tim,4 - '
(Streeraddress or Description of Location)' r
+'. > PURPOSE OF CONSTRUCTION- '` Sketch (attach construction plans if.appmpriate)
„.'DESCRIPTION QF CONSTRUCTION Gat grinder 10'wide -
'' green weighti` all else legal .... Y. HAUL ROUTE: NOGALES AND. VALLEJO
TI 'EZSENHOWER TO DURANGO AND
'E DIMENSION'OF INSTALLATION OR REMOVAL- Avenue 52 ' to out of City limits
�,t' '
k .77
a Haul date:' 2/20/91
*� SIZE OF„EXCAVATION,,IF NEEDED
APPROXIMATE TIME WHENaWORK•WILL,BEGIN= t
APPROXIMATE TIME'OF COMPLETION °`.
.' `IESTIMATED.CONSTRUCTION COST $
(Including rerhoval'of all:o6tructicn;'materials, and debris, backfilling, com=
I,. paction and placing. permanent 'resurfacing and/or 'replacing improvements)
4,
y#.In consideration of?the granting of•.this permit, the applicant hereby agrees to -u
'. r• ' } indemnify,•defend and s,ave,,the' City, its authoriied agents, officers, representatives and employees, harmless from and against any -and all
r, penalties,, liabilities or loss-resulting'from claims:or court action and! arising'out of any accident, loss or -damage to personsor property.
:happening^oroccurring'as:a'proximate result of any work;undertaken under•the' permit granted pursuant to this application.
Notify -the Administrative Authorityl�at least twenty-four •(24)'�hours.in' advance of ,the 'time when work will be started. ,
' Comply with alba' plicable.City Ordinances,,the'terms and condifions�of `the permit and all applicable rules and regulations of the City of
`
La, 66inta'ahaito'pay for�•any additional replacement necessary-'as•the' result of this,work.
•r '= I • ` • � '� ��, � ” � � ' • • � TG
ina racey
' a'h - I b r a • ` ••I t •
Sig�
,nature of Applicant or Agent
;''Tarmac/Massey, '' PO $oxf14050 _Pa1m£ Desera';, CA 92260'-
•
Name of Applicant'(please print):'r Business Address `. i! r Telephone No.
w, f
Name of,Contractor and Job5Foreman ..' . ;^4 -Business Address Telephone.No: .
i . o>ri<';fil� on- file
Contractor's License No. ,City Business License No. -
�' .on' file
Applicant's Insurance Company '' 1 Policy Number
. .x
FEES: Subdivision Improvement Permit ='Class III
;Public improvements: 3%0 of,estirnated construction costs
Private impr6vements:.3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
' Inspection. Fee $ PERMIT VALIDATION
PermitFeepaid permit 1002 1014
PERMIT NO..
'Penalty 2/19/91
Cash Deposit -Surety Bond ; DATE APPROVED
if requiredEXPIRATION DATE 2/20/91
TOTAL: $ 2/19/91
DATE ISSUED
Receipt No.
By—
Received
y Received by Date- 'Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
y^'..rs..: , ;r; h�. N,y., ��:. 'y..-...�:.. _ _ .. z: ., +�-�,•�. ; a :4.1 •-s-�..'.� q., 1,. � .�� ,i.
- !� �... , `� - �.,, ra iy �.. �.-�. .. I r�� _.^ter, 'y i. � � �.. .,,j _ � roa � -,. �' � - l
r•
U
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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
DATE
February 19, 1991
LOCATION OF CONSTRUCTION — movA PCYu i l3mAni-
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTIONF CONST CTION cat grinder 101wide
green weight, aelse legal
DIMENSION OF INSTALLATION OR REMOVAL
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
HAUL ROUTE: NOGALES AND VALLBJO
TO EISENHOWER TO DURANCE AND
Avenue 52 to out of City limits'
Haul dates 2/20/91
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 the City of
La,Quinta and to pay for any additional replacement necessary as the result of this work.
Tina Gracey
Signature of Applicant or Agent
Tarmac/Massey PO Box 14050 Palm Desert, CA 92260
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 file
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 paid permit 1002
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by r
1014
PERMIT VALIDATION
1014
PERMIT NO.
DATE APPROVED 2/19/91
EXPIRATION DATE 2/20/91
+Y' DATE ISSUED ,, 2/19/91
By—
Administrative Authority
TELEPHONE: (619) 564-2246
kHrr3�jlt?F�3re �"a'�,c?•.b.A;Awi'rAs.� �':.
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•P:O. Box 1504 y-{
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Wkhprt�ptar wtk4does• ^
NOTE, t
(frit form avnssiarbia en CITY OF ••LA QUIN'TA
entroachrrwnt permit r
?APPLICATION ,FOR PERMIT _
PUBLIC'WORKS CONSTRUCTION f ENCROACKMENTI
Far ma r rens Chen of pubtle or private curbs. driveways, pavements. sidewalks, parklnp late, Sewers, watt+a• ftlilw
and other Ilk* public Works Improwrnem In conneevon with MINOR IMPROVEMENT$ and APPROVED SUBDIVISIf3td$
,• t +j !� ^... Sltbdivltion Improvomiet Pa7rrilt •• Class III
DATE:
d Wow Improvwrw,es Permit Cdast IV
' 4 �_.._..�..._ .,�_. , ,
LOCATION OF CONSTRUCT(ON
• red I - •,� . i
(soot,waren or 0"M~ of Lowo4rr! q
.. 1,
PURPOSE OF CONSTRUCTION Sketch (attach Cor fiction a m if a
CRIPTION CONSTRUCTION
4 .� Zp
DIMENSION OF INSTALLATION OE: OMOVAL
SIZE OF EXCAVATION, IF NEEDED
i • ,
- APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS
t (IrWudinq removal of all obstruction, materiels, and debris, backfllliny, perm^
paceon End placing pei"wriai rt reeurfatdng and/or replacing impri n eras)
In consideration of the granting of this permit, the amicant harstry agrees to;
Indrmnoy, dentia and we the Cit#, its suthor+fad agemr, offtrsra, mornanatrm W4 ehwbvew. hormMH from an4 pest any OW alt `
panarpot: Iiewill" ar lop rewlrtrrq from clairm at court action and arm" out of env aaGd"T. Ips or damage to ere— - 41P Waiaiii W.
' neoaninq w ooeurerea Is a ot"Wrrats rm" 41 any worts uegwtntreh under Ma 00 RN VORtee ourwtwn to trig e001cat o". ,
"Ndtrty cele Admrmcuferve Aw*Atny a (,tact tuwnty-4our,t241 htwrt in 804"06 4f the lana when vrom wdt i>r ►terse.. .
Carndly vnm 111 9WIC lela CIN OrainwKye, the Nana Ver mndido"a 44 the t(ermn and all app ksbils ru and req###% m of the CIN of .
• U Quints and to pay for Env a wp i0rrel faU MMINAI neow"V as the R w T d h worn,
' c SI Mture Of pWreoln Agent . v �i�(✓f,
Mama of Aowieant (please ori ) Business Address Talapnono No.
Name of Contractor and Jac Foremen Susinass Address [echo" No,
c Contractors L-cen a o. .' City Suarnass Liven a.
' Aocugnt's lnsuf4iilice Company Policy Numniv
v
Subdivnion IntorowatearPermit—C1ass Ill
t ` , Public imcrovat"Mfrtt: 3% of a'sttmated eonetruetion vests
1 Private improvements: 3% of animated conatrvetlon costs
` Mtnor Imorovemont Permit — Class IV: See atmcndd schedule
r imoectlon rev S PERMIT VALIDATION
Permit ° °AMIT •'D,
I N ,
Penaity DATE APPROVED
Cuh Oaoostt•Sursty Borui
If required EXPIRATION DATE
„ TOTAL: S
DATE ISSUED
Rec.rpt No. _ � .1• . ,
_ fiv
Received bv` Date—