1016,f,.' +".y."3: .'�� r ' •nr- �..� ' :`•r _ �r -' _ tr ^, „yam,. .. _. - _ ,... • „ o •...., !. � .,.�.,..tis,..,,..f! _ .:%;7 N •.,t.,
NOTE'-
With
OTE With proper validation
�thls'.form constitutes an
n,. CITY OF 'LA QUINTA
encroachment'permit:
APPLICATION 'FOR PERMIT. -
POBLIC �, WORKS CONSTRUCTION `{ENCROACHMENT)
"'411 ;S • - - • a ` , . C pF.,I,Ag
For,'the' construction•, of,,'publlc or "private curbs,, ydriveways, -pavements, sidewalks, parking Dots sewers water mains '
- ' and other like .public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS'
222 Subdivision Improvement Permit -`Class III x
DATE: ' ^ J `Minor, Improvement Perm_It Class IV' r A '
t: ]:_ �. • _ - + .: r r • , l " r Ja 'rt y"S: y r1 •J 1
k
LL ,LOCATION OF CONSTRUCTION
?*; (Street address orDescrip"tion,,of.`Location)`
F F 4 r ♦ t
;F 'ifr,PUItPOSE OF�CONSTRUCTION k 4Sketch,(attach--constru.ctlon plans fapproprlaie)
i f '�. .5 }• +., � _ ;k ,�t /+a `S ri r- N 1 �{ 4'fe.'ea S + *'i
GRINDER �'i5" WIDE' • . s; r �;. ,-; ��'
DESCf IPTION OF CONSTRUCTION
d� EIGH' GREEN MIGHT HAUL ,AOU i . VAL ,EJO AND f�#O LES
TO E 1,D]WHOW R AND NO>�!'i Q� 5. 2, x
s ;.,DIMENSION OF INSTALL'AT10N OR REMOVAL
4 `
AND EAST TO . C.`ITY 'LTMTT .s'
HAUL:,PATE', DATE° 2' 25-- I91
SIZE OF EXCAVATION, IF NEEDED - ,.. -
APPROXIMATE TIME WHEN WORK WILL BEGIN a
APPROXIMATE TIME OF COMPLETION
�. ESTIMATE D`CONST'RUCTION COST $ f a 4
t•.
(including removal of all obstruction, materials,'and debris, backfilling; com *-, t
paction' and placing permanent resurfacing and/or replacing improvements)" "
Inconsideration of, the granting of. this permit, the applicant hereby agrees to:: R
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 properiy .. R;
;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 �s
' kLl Quinta.arid to•pay for any additional, replacement' necessary as the result of this work.
t.
Signature of Applicant or Agent
tc v Y tt n 1 b n a
Name of Applicant (please print) Business Address Telephone No _ ,•F�
Name of Contractor and Job Foreman Business Address Telephone No.
• ,f { h1t1 F'T1':F. s ` i' -
;Contractor's License.No. City,.Business License No..'.,.
vitt rr.
Applicant's".Insurance Company " x . Policy Number; `
FEES:' 'Subdivision- Improvement Permit— Class III '
Public. improvements: 3% of estimated construction costs ,_1 �R;i
Private improvements: 3% of. estimated construction costs,
Minor Improvement Permit —'Class IV: See attached -schedule!
rye ! - ,.t ;2' is :.�I. . �• .�� Sart .t 4 f li'
-1Inspection Fee $ PERMIT VALIDATION
f' Permit' Fee
4r > PERMIT 'NO: 1Q�6 t�
�.. Ea
Penalty tr `r - f: ,. 2=2291
' DATE APPROVED'
f• 'Cash Deposit$urety,Bond �• ,
t , r` if required EXPIRATION DATE r
TOTAL } $ � 10.60 l . , 3 tur,
.. DATE 'ISS ,ED� �!/ 2� 2 91
tx ^.Receipt Nod ' ti
y Received by'` Date By . `�•....JAdmlmstrative Authority
r' Recorded by TELEPHONE: (619) 564-2246
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NOTE: /
.' With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit ,
t�'r* APPLICATION. FOR .PERMIT '
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT'
��
SOF
For. the construction of, public or private curbs, driveways,, pavements, sidewalks, parking lots, sewers, water mains
an&dther like public works improvements in connection with, MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement -Permit —•Class III
2:-22-91
DATE: Minor Improvement Permit Class IV
"i'LOCATION, OF CONSTRUCTION
(Street address or,'1escription of Location) • a, * `
PURPOSE OF. CONSTRUCTION k $ketcFi (attacl,construcUon plans If appropriate) ._
DESCRIPTION OF CONSTRUCTION GRINDER 916" WIDE 1'
✓ k
4.Y .RIGH GREEN WEIGHT HAUL ROUTE: VALLEJO'AND,NOGALES•
j TO EIDENHOWER AND NORTH. TO X52 f
DIMENSION'OF INSTALLATION OR REMOVAL -
AND EAST,TO:CITY LIMITS
SIZE OF EXCAVATION, IF NEEDED HAUL DATE' 2-25-91 r
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. }•
Signature of Applicant or Agent
TARMAC' MA9gVV CAM11 A"ND '00CR V MI BOX 34450 VaLm MSER t+ CIV 07 c;5%
Name of Applicant (please print) Business Address Telephone No.,
Name of Contractor and Job Foreman Business Address Telephone No.
ON FTT,R ON FILE
Contractor's License No. City,Business License No.
ONFTLF
Applicant's lnsurance•Cornpany Policy Number
FEES: Subdivision Improvement Permit — Class I I
Public,improvements: 3% of estimated construction costs O 16
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee- $ PERMIT VALIDATION
Permit Fee ' 10' 00 . 1016 .
• PERMIT NO
Penalty
.Cash Deposit -Surety Bond
if required'
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
2-22-91
DATE APPROVED
EX,P,IRATION. DATE 2--25-91
2*22-91
DATE ISSU�'D�
By t
'Administrative Authority
TELEPHONE: (619) 564-2246
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this forth oar xftrtw an
.. •� � ent�oadtnrerttotxmR � •CITY .QIF LA QUINTA '•'. , .. • ' :.;:,:..,.',_,;.
APPLICATION FOR PERMIT
PUSLSC WORKS CONSTRUCTION (ENCROACHMENT)
For tree construction of pubtk or private curoa, drivewMvf, pavements. Sidewelki, parking lots, sewers, weoar tttalttr.
and other like Duolic works imprve+men'n in eonneman wilt MINOR IMPROVEMENTS and APPFIOVED SU801VISIOM
�} r 9/ Subdivision Improvement Permit - Class Ill,
DATE:- ,w,( O` Mlnor Improvemam Petmrt cum IV
LOCATION OF CONMUCTiON
(Sum eddrt” at I)asrnpt,on It La+wr"I
PURFOSE OF CONSTRUCrON - - -
OESCRI ,SAN OF JCON Rt1CTION
01ENSION OF INSTALLATION OR AMOVAL
$IZE OF 9XCAVATION.IF NEEDED
JSketrh (attach oo "Meproh surd)0 spptpppla
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION - — Ts.64j
},y
ESTIMATED CONSTRUCMON COSTS � ; •; ; ; `'`':
(Including tvrr4vei of ata o0rouction, irmnala, and debris, batkfillinq, corn.
paction and placing p4munent rer[a`fse:ng and/or replacing Improvemental
In consideration of the granting of this permit, the applicant heretty agrees to:
Indamrnty, datertd Ana " the Clty, tis author+tao Mena. orficm. Rpmw utrwr and anorovawa, harmieu Irani sno aorees ens tine all
penritwo. 404111" or tore iewiprtg hem da4mt or eoVrt action ado srrono wt of a" auideht, foci or dhmwp to trarON ea Prettsrev
hwo"ing or owurr" a a pro■tm to wenn of my worn Vttawokso oftw the oe,mrt onntod ourwwnt to this apyterwoee.
Nowfy ins AdM1A*%M nv AVV%*nW st NuM tw"w4our 1241 hours 0 aeMnrrt 01 the ams ionto wan[ will be mm. '
Comair vnth ail aopiKaote GN oroiFd a, me rani and conditions of the frermn end ye sarttkMV& evies and torAfterw of the eJty of
L Cwlnq ma to flair tar any boontanei rr 4 mmt nwmw v as too "At of into wbm
arma-c./ 11Q 'g�. .
rtaturs o Appuca or Agent
e t r
Name of A0011ant 10106a, orint) 9uliness Address Tojepnone No. r::r
:•gip'.!',
Name of Contractor Jo Foremen Business Address T ton No.
Contractor't L,aansa o, _ CitV Business License No.
•• ,rr .
AochcatWs Insurance Cot=twi Policy Numoor
FEES; Subdivnion lmorvtn vont Permit -Clan III
Public improveffwIts: 3% of erttrneted eonmuuction cosec
Privets improwtttertttt 3% of tuantated conswA ata costs ATO
Mittal Imorovemrnt Pertnit - CUU IV; See attacpieo rehedule
In:oection Fee S PERMIT VALIDATION
Ptrmit Fee
Penalty OATS APPROVED
� C40Deaos}t-Surety Band ,
I if MClulred EXPIRATION DATE _ ... ....,......
TOTAL:
•". •" ••. "" DATE ISSUED
8Y . t '��'; ' ,� _ '•„..••:'''4' �,,,. � Via!:.,:�^;;'
Received by
1 •r'rr
` At4' �. .t
#-
. .a1 4� - . r -J.. I•� ,w .;e A•' 1 ,�R •l • , T ��'' L.
'
F •
° r t
NOTE: '�' . �� ,a ; e '
{
With proper validation
this form constitutes an `.CITY OF LA:QUINTA' •;
r,
encroachment permit .` +
°
_ :.x• ` APPLICATION FOR PERMIT.
'
- r
{ �'
f PUBLIC WORKS . CONSTRUCTION (ENCROACHMENT)
.t om
+ " . Zr ° }' C�"tOF IE��ws
'
For the construction; of public or private curbs; driveiways;"lpavements, sidewalks, parking lots, sewers, water. mains'
" and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement P — C ss I I I
2-22-91 ermit
DATE: } a 4 ," Minor Improvement Permit Class IV
.
' LOCATION OF CONSTRUCTION s -
•
"
`
- ".4 (Street address or Description of Location)'
PURPOSE OF CONSTRUCTION " r Sketch (attach construction plans if appropriate) `
y
`+'"
L DEjClF IPTION OF CONSTRUCTION GRINDER RINDER 9.6WIDE
14 HIGH GREEN -WEIGHT HAUL ROUTE: VALLEJO'AND NOGALES.
►
TO EIDENHOWER AND'NORTH TO 52
DIMENSION OF INSTALLATION OR REMOVAL'
` I „''.
:•'• AND EAST TO CITY LIMITS
` ~
SIZE OF EXCAVATION, IF NEEDED, { HAUL DATE- 2725-91
'•
APPROXIMATE TIME WHEN.WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION'
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling com-
•
•paction arid 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 124 rhours in 'advance of the time when work will be started.
e
#.' 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.. `_ - •• '
OL
'" ' µ
,. . -' . Signature of Applicant or Agent .. >
r '. 0. -
`r
., TARMA(' •/ MAccFV entat, atm nnrtr n n BOX 149513'P111,r1R DR SER�C71 9aa��
., ti' •
t Name of Applicant (please print) } Business Address„ Telephone No. '
+
Name ofContractorand Job Foreman Business Address Telephone No.
r
.f)N FTT.F. •.' ON FILE
Contractor's License No: • City Business LicenseNo?'
`,
y `
ON FTT,F. f Vii,:. r; ' 0, y
Applicant's Insurance Company , Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated, construction costs 1 016
r ti.
Private improvements:'3% of estimated construction costs
f . Minor Improvement Permit — Class IV: See attached schedule z • + '''� "- ,
c
, Inspection Fee' $ - PERMIT VALIDATION
.
,
Permit Fees 10..00 ••'107.6-
'PERMITNO.r
. y.
_ • r`
' '
r ,s
Penalty .• } 2-22-97
Cash Deposit -Surety Bond ';7^ DATE APPROVED `
if required . ' — , EXPJA DATE;2_ —
-91
t
'TOTAL: $ 10.00 ''D t2
• 16S 22L-91
-
Y Y «
Receipt No. - ��•
«,i.
Received by ` Date' " By -- • dininistrative Authority
+.
11
Recorded by` • -TELEPHONE: (619) 564-2246+
=
I