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With. proper. validation
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this form constitutes an `• fi
- CITY OF LA.QUINTA
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encroachment permit �, ; t
APPLICATION "[FOR PERMIT
t+
;,PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) ; .'` .� •.� ' �'
C`t�f0F
Tf�O`vS
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For the construction _of public or private curbs,'driveways, pavements, sidewalks, parking lots, sewers, water mains,
andother like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
' `•' i
- •� Subdivision Improvement Permit = Class III
..
3-28-91' r
DATE: Minor Improvement Permit Class IV
•` y,
-
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LOCATION OF CONSTRUCTION "
.,
s
(Street address or Description of Location) . ��• 4 K k
•;., _
.�•
PURPOSE OF CONSTRUCTION . BARBER GREEN EN PRURRSketch (attach construction-plans if appropriate)'
X10 t 6" Wide green` taxi ghf• a1 1 of se ria) f• �. �, -HAUL,'ROUTE: 5'2' AT JEFFERSON
DESCRIPTION OF CONSTRUCTION. ` e.'WEST, TO--EISENHOWER &, SOUTH -
r • .
- TO NOGALES x
fi
v DIMENSION OF INSTALLATION ORREMOVAL
r
HAUL DATE 0-28=91 ' s
-
SIZE OF EXCAVATION, IF NEEDED
f
APPROXIMATE TIME WHEN WORK WILL BEGIN40_
j �- ,� •t.
N
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS
{ i
_.(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-ofrany accident, loss or damage to persons or property
'
f i 4'o
- - happening or occurring as proximate result of Shy work undertaken under the permit granted-pursuant to this application. . "-
�of
`- :Notify the Administrative Authority atleast, twenty-four (24) hours in advance the timewhenwork will be started. '
•; I
-y Comply with all applicableCity Ordinances, • the terms and, conditions of the permit and all applicable rules and regulations of the City of
La Quinta and;ro pay for any additionalreplacement necessary as the.result of this fork. ',•a
. Signatu_re'of Applicant or Agent, '
f TARMAC•MASSEY DAND AND ROCK P-n=°Rnx 1'an E
5 (L� IIR�fiR•�'
Name of Applicant (please print) Business Ad dress .. 'Telephone No.
Name of Contractor and Job Foreman , Business Address . _ rt Telephone`No.
of ..
ON FILE r r • . ON -wli
R
Contractor's License No.: ., !' ° , City Business License No.
=
ON FILE • a ^ ' }
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Applicant's Insurance Company # Policy Number ;
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FEES:, Subdivision Improvement Permit - Class. III
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Public improvements: 3% of estimated construction costs
• .j, '
V. Private improvements: 3%of.estimated construction costs ,t -' ` ' 1 Q 4 1
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Minor Improv ementPermit - Class IV: See attached schedule
Inspection Fee S'
PERMIT -VALIDATION .
_ ..
� _ -
10.00
Permit Fee
1041 -r
i
PERMIT.NO.
fpm
Penalty .
DATE APPROVED e 3-28-91:
Cash Deposit-Surety Bond _
-
ifrequired '
Y y
E ATION T
1000
3
3-28-91 '
,.TOTAL'
AT I U 1.7
-
-Receipt No.
as
Received by . Date
• rative Authority
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Recorded by-" �'
TELEPHONE: (619) 564.2246-<
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' entrolehrrmemPermrt . '�' "o .• •. � :''?+�r •;,',: � . ��irti�u.
APPLICATION FOR PER
MIT
PU13LIC WORKS CONSTRUCTION (ENCROACHMENT)
V.
For the st cvon •.•„ o;'A:',n
cdn of public or pnyat/ arms, drivew■yt, paverrtantr, Sidewalks, parking Ica. se�wr,r, wsls►•'nreiteti .fit:;;`• �-
and other like public works jMW*vvno t in conneman with MINOR IMPROVEMENTS and APPROVED SuaDIVISt4NS
. 'zz,
Subdlrhlon Itnproverrartt Permit — Ctasa III ;;:.:I.f��t,'„t�
DATE, Minor Irnprov■ r nt Permit Class IV
LOCATION OF CONSTAU=ON
15treet ow" or oamvooa of Loon”
Sketch
PURPOSE OF CONSTRUCTION -- (attach tonstmeti
1 cn pont N ■ppropeilrta}
OF�St;R ?TION OF ONSYRULMON 73 77rJ eC.
I. r Je.irXri,
DIMENSION OFINSTALLATION ORREMOVAI
SIZE OF EXCAVATION, IF NEEDED _,C �✓/j Xo, f. 41
APPROXIMATE TIME; WHEN WORK WILL. BEGIN � Ll fy� e✓
r.: '•�M
APPROXIMATE TIME 13F COMPLE^MON / ��� /J_'��--'�� ,'. •��t.��;l,,}�
ESTIMATED CONSTRUCTION COSTS �au f ✓ !' `l ` °` `'
(Including femoval of all obstruction, tt onals, and debris, backfilling,
paaaan and placing pormarlerrt rmin"Aa9 Ind/or replacing imorovemorm)
In consideration of the granting of this permit, the epplipns hereon agree” to:
Ind•mmIM, tlef■ntl ern o7f the CItV. tft ruelontvtl egelrl], eMlCerr, Mof+EentrMee and efntl,OVea, hurnNq hgrrl and M1MM+t afb tiYd all
pe6•,h01, Il•brlitler of leg rwkdd tMM 66MII Of C04It &MtOn enrl eftl,Nfl Luh of enY owtdent, IOei Or ' ,• "�" "'
nsI aamrge to peHIDrN Q.t t+raoanmr
r,.:..
- hepppurq 9r OtXLL+nrl9 M e ptoxrfgtf tea.lt Of Onmt YlOfk UROeM'trlen Ynt,■f me Per'n<R arent•a DYffuent t0 Mlle rpWle•von,
• Nollty Trio Alyttrnmeravw AuehprrtN at her'{ ManrWour 1241 fttwra In sdver+rx Of the tune wh•er ntlprnt Ynll be 1u.ae. � ', ;� �_';,F'•^�� •
eomoly «,ar ell oweapt■ atv or"bummi, the team erld eonaitroro of "oormit and all awhcotta rola and m/watrow of the City of
^is;Jpr
L Qti,lnrs enc t0 Pay for erlY ad4Nt'IeeaM ntoreoernerK nwnyxmr as We raeutt r thh vv".
ignatura f Appowt ar Agent .'^` { 'r;"•
Name at Aeouca�Jow onntt usiness A dre TNa No.
r d 7t axone ri.px
Name of Contra r jn_o Jam ForemanIn
Susineas.Address %� elsQhotle
J
Cantractar's Lrtans No. CitV Suslneu License No.
Aoohc4nt's Insurance Company POlith/ Numota! a . , "`w yy'c:'
FEES: Subdivision imara.emermc Permrt —Chau IN
Public imotovements: 3% of
essu+masee eonmvatlon toms '}' ;fir::,• .
Private improrenhen[t:.3% of esarr»tad mntes>tctron cover *7 �.:•,; • . ,
lel O . �• ���4•' �� ��
Minor Imtlrovornerls Pemrlt Gast IV: Sets etgcn■d schedule • 's ;�,x,:: ' � '
Inat*ct,on Fee S PERMIT VALIDATION
rmlt Fee �SAMIT';1044 1
CashEland De \ OATE APPROVED
oos,s•Surety
`�"--�--= it f6auffed
EXPIRATION DATE
TOTAL:
'� Ii a•,
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NOTE:
With proper validation
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: 3-28—�� + + Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location).
PURPOSE OF,CONSTRUCTION • BARRPR Sketch (attach construction plans if appropriate) .
10'6" Wide Qreen 'wei aht- all pl fiye 167 HAUL ROUTE:.52 AT JEFFERSON
DESCRIPTION OF CONSTRUCTION. WEST .TO EISENHOWER &SSOUTH '
�TO NOGALES
DIMENSION OF INSTALLATION OR REMOVAL N
HAUL, DARE 3-28"91 )
-SIZE OF, EXCAVATION, IF,NEEDED '
APPROXIMATE TIME WHEN WORK WILL BEGIN _.
APPROXIMATEwTIME OF COMPLETION ,
: ESTIMATED CONSTRUCTION COST $
(Including removal of'all obstruction, materials, and debris, backfilling, com-' '
paction, and placingpermanent 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 (241?hours in advance of the time when work will be started.
Comply with alliapplicable 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•t_he result of this work.'" '
Signature,of "Applicant or. Agent
TARMAC . MASSEY DAND 'AND ROCK P . O PDX a A n 9 o p A J.H nE:SE!3R2
Name of Applicant (please -print) Business Address Telephone No.
Name of Contractor and JobToreman, Business Address Telephone No;
ON -FILE
Contractor's License No. City Business License No. -
ONr F -
SLE
r, Applicant's Insurance Company Policy Number N
FEES-.'-. Subdivision Improvement. Permit — Class I II
I Public improvements: 3% of estimated construction costs10,1
,
•s w a
I - - Private improvements: 3% of estimated, construction costs " 4
i
'
'Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ "PERMIT VALIDATION
'10.00
1041
Permit Fee PERMIT NO. '
Penalty
Cash Deposit -Surety. Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
a
DATE APPROVED 3-28-91.
EX•P ATTR T
DAT :1 SUED 3-28-+91
92
By
x. `Administrative Authority
TELEPHONE: (619) 564-2246
d a.
t� y
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
M °
Subdivision Improvement Permit — Class III
DATE: 3-28-91 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION — BARBER GRF.ENIRRAVMR
10'6" Wide_ Sreen weight all also 1 =qa1
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
r
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HAUL ROUTE: 52 AT JEFFERSON
WEST TO EISENHOWER &SSOUTH
TO NOGALES
HAUL DARE -3-28=91
t
APPROXIMATE,TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ T
(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 resultingfrom claims or court action and arising out of an accident, loss or damage to
9 Y g 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.
iw
Signature of Applicant or Agent
TARMAC MASSEY DAND AND ROCK P.O. BOX 1405n PAT.m Tmgrmll
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman }', U Business Address Telephone No.
ON FILE 1 ()VT VTT.E
Contractor's License No. City Business License No.
ON;' FILE ,
Applicant's Insurance Company ' L/ Policy Number
i
FEES: Subdivision Improvement Permit —Class III
't Public improvements: 3% of estimated construction costs
' --• Private improvements: 3% of estimated construction costs 1 0 4 1
Minor Improvement Permit — Class IV: See attached schedule
t'
Inspection Fee
eJ
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
10.00
$ 10.66
Received by Date
Recorded by
- PERMIT VALIDATION
1041
PERMIT NO
DATE APPROVED 3-28-91
EX•P RAT�ATEA 3-29-91
3-28-91
DAT - I SUED 1_�?
By
Administrative Authority
TELEPHONE: (619) 564-2246
wiw��.«��_.4..�-n,,•.- .. �'+,rte �..�.}i#`+�Y ,.
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