1046Or
NOTE:
With proper validation
this form constitutes an
CITY OF 'LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION.- (ENCROACHMENT)
OF
For' the construction of public or -private curbs, driveways, pavements, sidewalks, parking. lots, sewers, water mains
and other.like'public works'ihiproveme.nts in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III.,
4-1-91
DATE Minor Improvement'Permit Class IV
1_6CATICIN-OF CONSTRUCTION
.;.(Street aciclrieis'�or be I scription.of Location)
PURP65E.OF'CONSTRUCTIObel#aCl Ori ndP*' Skefbh (6t6ch constructionpians'if ap"To�ri
p aie)`k-
,9 viiidia 14 hi green wPi t ht lcnga 1 1 tmngt
DESCR iptioN,&F CONSTRUCTION haul= ' route: 52 'and ftl-le- 'kbrido
to Washington and north t10.,
HWY 111!
"":DIM ENSION'OF'INSTALLATION OR REMOVAL
haul date, 4-2-91
SIZE`OF,EXCAVATION, IF NEEDED'
`,,APPROXIMATE TIME,WHEN WORK WILL BEGIN
r, -APPROXIMATE TIME OF COMPLETION
• ESTIMATED CONSTRUCTION COST $
Inc*lud!ngremova I materials, and debris, bickf illing,, com-
.'of all obstruction, r
-paction and placing permanent resurfacing and/or replacing irhprovernents)
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 accide'nt,,Ioss or damage to persons ortproperty
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'Ouinta -ancl'liothis work.
Signature
pay for any additional replacement necessary as the result o
Signature of Appli6ant'oir Agent
Tarmac o'.' box 1.4050 Palm Desert CA
Name of Appli6ak'(please print) Business Address Tel6pho'ne No.
on file
Name of Co k.ra6tor and JobForeman Business Address Telephone N6.,:
on -,file on file
Contractor's Cicehie No. City Biisiin e*ss License No.
_V1
Applica,nt's Insurance.Company Policy.Number
FEES., Subdivision Improvement Permit — Class III
Plublic improvements: -3% of :esiimatecl construction, costs.
-improvements: 3% of estimated . construction cos -, 10 4'6
Private s
t
Minor Improvement Permit —Class IV: See attache6 schedule.
Inspection Fee $ PERMIT VALIDATION
Permit Fe 10.001 .1046
PERMIT NO;
Penalty
t'
Cash. Deposit -Surety Bond • DATEAPPROVED7—
if, required• RATIO.. DATE 4 ,— 9 1
• lono
TOTAL: $ 91
..DATE ISS ED''
Receipt N6.
By
by Date% Administrative Authority
Recorded by` TELEPHONE (619) 564-2246
�.T•!:'r: "'7,, •�"'"ny�f!`r{re�-ti ,_...,r�"^,...:\,,,�f-.--.'�+.:'•t`r-.+.�-�`,�Y�'��'4.i •�.v.!'+'ti.Y'i-'. ►:.-':.o.!'"F,.--�'rr "•�t•r."�-�L=i .r"`�•-.�,rF.�., �t`�.-�.�.e .`. �; f :��'•�_. =,.i•. ��.ie,
13'i .
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r
ti•a
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 II I
DATE: 4-1-91 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTiobe§ag grinder Sketch (attach construction plans if appropriate)
916" wide 14 hi green weight legal length
DESCRIPTION OF CONSTRUCTION haul route: 52 and dalle Rondo
"j to Washington and Borth to
HWY 111
DIMENSION OF INSTALLATION OR REMOVAL
haul date 4-2-91
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 personsor 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 p.o. box 14050 Palm Desert CA
Name of Applicant (please print) Business Address Telephone No.
on file
Name of Contractor and Job Foreman Business Address ( Telephone No.
on file on file
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs O
Private improvements: 3% of estimated construction costs
46
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No
Received by
Recorded by
Date + ^
PERMIT VALIDATION
PERMIT NO. 1046
DATE APPROVED 11-1-91
EXPIRAT_IO.N_DATE 4-2 91
DATE ISSUED, 71-91
By
Administrative Authority
TELEPHONE: (619) 564-2246
h
.�. a
4' �
V, ff14W M,
pripar rF Y
"".With
;,-'..thN form corivitrwan,
CITY OF LA WIWTA"w;'
-g
-`r-'APPLICATION FOR PERMIT
PUaUC WORKS CONSTRUCTION (ENCROACHM
For in@ contmc;tj n of� puWIC ar,'Pr did voinarm, sid
iv curcs. drive"", 03 amika,parking louo
r. and other like public "a irnWw,&mgftb; in connection with MINOR IMPROVEMENTS and APPROVED SURDIVIS IOW
Subdivision Improvement Pe"ri CIM III
DATE:- -.,Mtnw 1mpVM1*M Permit dsas IV
LOCATION OF CONSMUCTIbN
40
PURPOSE OF CONSTRUCTION
Skom (stuchIf a
.0,
77, lee.
DESCMITION 06 CQNS�Ry
9 4
A,
01MVINISION OF INSTAIATION OR REMOVAL
SIZE OF EXCAVATION. IF NEEDED,
APPROXIMATE TIME WHEN WORK WILL BEGIN
;0-
41%
APPROXIMATE TIME OF,COMPLETION
ESTIMATED CONSTRUCTION C= S
I obstruction. mrtwils; and debris, backffl6q, cam,.
jInClUding rty"I if j)
Pacton and
In ciamsidairavoi4 of tho grantiN of this Clert�nix, the �Slpiic:lnt hereby
;Rdomnity, i#Iend ants a" 'Me c1tv, in iluglontets wa. officaril, toot "rnisiff" ontlP111MY1011 fMM 1110 bpaina a" ene go
itr Was tiaajlvsnv tturn CIA -M at coup action an* utsinipi O -A at aw acc-afrit. lan at "qlip to pvww w
jR hoop"Ing proonks rinwit of any W*ft, umftiwi V"w the am" gnioted pvm"t to t"to solatexamt.
Nostify Via AdMiftfa;rm" Au*ianw as WA tWi"4Wr 1241 haiffl in WwWocli at the tiniat Whih;
waft Toll be arse.
th 411 seewbotdo Cr%# otoinallims, aw wim Ind avvitoft of the to &0 all 4100licrill. Niel Aft RMktwnoft of *0 City at
to carr weir oddetloiw rwaimffmn notiammy is the Mot Of 'this viiew
N
Name of Anucani Ipleast arintl
Business Address Tate No.. No
Name at Contrataw Foreman
Business Address T No
ph"
so No Zle
-No.
City Business License
Y'
X
ApolAraintlai Insurance ,°: PQJiCV Nurnaer
• FEES- -Subdivision lmmvnmwnP�rmft-MUj1I
'Public: mp no: 396 of amnaw comu=ion wrts
Privat; immoverne"U. 3% of • mmistid Wnriuman *am
No
Minor (MMveifnitnt Pffitn't - CIM IV- See liMcnod schedule
hiciection Fee - •PERMIT VALIDATION
• P. mit Fee
penalty
• Cash 000MR-Surat; Bond DATE APPROVED
if reautriad
FXPIRATION DATE
TOTAL;
:OATE ISS %%
UED.
P, A
-;X.- Amnied 6v"
Cals,
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With proper vblldatlon . +4• .
3
fth 1. form apnatltutua an C1TV OF, LA MUINTA '
.rO.Mm.rK permit �,,
! .
- APPLICATION FOR PERMIT
WORKS CON/iTRUCT10NfHNCROACMM9NT/
'
•
Por eh. —et—l— of publle or privets" orb., drivewetre, pay.m.nts. elci—alk., perking lot., m er., W.Iter main..
,y
.nd ether Ilk. publle work. Imprevernente In--irclon with MINOR IMP-ROVEMBNTS and APPROVED EUBDWIEIONB '.
•
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• 14-1—DS • -}J • Eubdlvlerove
lon Improvement Permit =0ieee 111
. •
1. DATH: - Minor Improvement Permit Clap IV _
'LOCATION
2. t rtI
OF CONSTR UOTION '
i< f 1
yf
Ye ^a' les[..<.tldr.Y er OemrlPLen a Le.ntlen) t J
•
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PUi�PO&g OF QONETRtlCTlgpp �a.n.eQ Q�a ^w�" 'Sketch settees, aen•truotlon olar±. It appropriate)
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9 JR5._ tains >_.a• e, t. Q>^....r. �a.a ri•.« �e.�t •sw�.r. � [�F
0966RIPTION'43P CONSTRUCTION 52 nz> sl, Cn11— Rors80
_
• -
- _ •to wa aesia'ptoa nlnG: Mortes to f
EE97Y 13.
'.
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DIMENSION OF INSTALLATION OR REMOVAL 5.. r r
r
hcU1 Bn t® 4-2-91
rr
f -•
612E OF EXCAVATION, IP NHEOEO
•'
., APPROXIMATE TIMES WM9N WORK WILL BEGIN
•r .
•
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APPROXIMATE TIMH OF COMPLETION .L
• ,r .
ESTIMATED CONSTRUCTION COSY 0" - - s '• y ,
• 1 .. _
•
flnpludln0 r.moval of all ob.truatlen, mptariab, and debris, baekfllling.
peatlon` and pleaing permanent r urfaeing end/or r.plaeing ImproV.mentt)
{r1
neidaration pf rite gr.nting of th It:Permit.the applieent her.bV•egress
A, - -
t Ine....nLv ..erne .•,n m • gnv. h. a.: Ta.a' boenu.'oeoaer:...ea...•ne.nve. ins e - !Pra.o.•n.....i..: trp...:..:t —I... ails, n. I, '
e!e .pPela.m.
•
i' F.n.lal... iieemtl.• p. l..e rr .. I.Y .r aemy. w when. or v
=,n, on..rl•Ing o.. or .
In01• ulmrt.r •ult. et e V work •e.n one•♦ u, a a.. s erana.d pur•u •nt so thl• .ppller<bn.
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NotIN nW,.alr. A�f;•prhV .< r.Ya t•wntr•r.ur /eel rheur• In .dvenee.m �ele •.0 when wore .will bs et.r<ee. 1 ^
11 • .w - 'l
C.—ell —1,. .ill ep.11eable CI[Y .Ordln.ne... ahe mon eendltl.[[• .1 <s,. P•m•It •.•pl. .eplleeb . ru^e• .rW [.solo<l.n• et the CS- .f -
LO Ouln[•"and t O Y .edltl.n.l _r .e• • ult et ehl• w ..
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.} ; . .0 { .• ` - • Hlgraatur. et Applicant or Agent .• `
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T Tazatao-' n.o: )*QX' 14030T61fn Daoart CA r -
�-).
j' N.— et P
Aplle.nt (plan.. P's—) Print) Eu.IMp AddNe
r..e - Telephone . '
1, ern ;Fulls• J. • j .. .A ,. _
N.— ut Cpntr.otor end Job P—man - 8-1— Addr.p_ - • T.I.ph— No. -
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on- i[ii'.t-. 1 • .•t
.311® -
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Corttreator•. LJ..... No. C:ty 11-1 ae Llwn.. No.
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Appllmnt•. I.—conal. Comp.nY - - • 1 PoUlcy Number
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PuH9.-, on Bubdlvleli[npray._n Permit—Clem 111 t -
•o
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^ Publle Im P,le—montt: a% of aetlmated eenstructlon Coote '
r• [
'..
Prive" Improvem.n[al 9% eT e.tinvt.d cO.ts ... - ' '
•. • ; l
_een.iruotlon
t ` me—, Improv.m.nt Permit — Clap 1 V :' Bee atteehed .eh.dul.
y Y' J -. 1
y1:•
In�p.utlon Fee m r
P@RMIT VALIDATION
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PERMIT NO.
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P -1w •e ,
OATS APPROVED ®t -
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Cons, D.po.it•a7ur.eY Eend [
•
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TOTAL:• f ` 9 10.
DAT ISS D -Lox
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r Reeelved by.-^.�. L� Deta��
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rly. Authorl,y
's II
R—el.d Ill
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Ti4LEPHCNG:•(BID) 664-2240IsJet
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(REDUCED
-SAMPLE,'ABOVE) r.
WAS SENT'
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XEROX TELECOPIER'7020 ,
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IS
- - - - - -
a —_--__—_— _____________________ 0---- — —— • — __
f NOTE:.
4' With proper validation r a r
r r this foam constitutes an •'" ' CITYAOF,L'A;QUINTA
' encroachment permit - ' t
A. a 4, APPLICATION FOR •PERMIT ,,'{.
PUBLIC WORKS CONSTRUCTION; (ENCROACHMENT)
VI -
For the construction ofpublic or private curbs, driveways, pavements; sidewalks, parking lots,'sewers, water mains'
I and other like public works improvements In connection with MINOR£IMPROVEMENTS'nd APPROVED SUBDIVISIONS
tr
IlkF
4-1-.91, f rt jSubdivision rorvement Permit ='iClass 111
DATE:
f
Minor Improvement Permit Class IV'
•+ LOCATION OF CONSTRUCTION 1' `
+Istreet address or Descrip{ion of Location)'
+ • Y,` M ' ` 'PURPOSE OF CONSTRUCTIObemdtans if a
a� Qri nPr ' ` Sketch (attach construction
~' 9' 6 "wide 1'4 hi gret
green wi gh1 Pl e
ga 1 'ngf•h - P appropriate)
DESCRIPTION OF,CONSTRUCTION haul route:: 52 and 1 Calle Rondo_ x
to Washington and' North to
HWY 111 r.T
• " DIMENSION OF INSTALLATION OR REMOVAL•" `� r
r haul*.date 4=2-91 • ,
5 'SIZE OF EXCAVATION, IF NEEDED1 ILr
APPROXIMATE TIME WHEN WORK WILL BEGIN - t t f
r •r r'' "' •,, APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ ' r3
r • + ` ' (Including removal of all obstruction, materials, and debris, backfilling, com-
paction-and
om-pactionand placing permanent resurfacing and/or replacing improvements) f
Inconsideration of the granting of this permit, the applicant hereby agrees to: .' +
'ti• y - .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 r damage to persons of property
happening or occurring as a proximate result of any work undertaken under the -permit granted pursuant to this application: _
-..� ' • �•
,y - .. - .' j' • +,� -' Notify the Administrative Authority at least,wenty-four (24) hours in advance of the time' when work will be started. ,• "' ' "'
`� `"' •" i 1 + Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
a
'La Quinta and to pay for any additional+replacement'necessary as the result of this work:
r' Signature of Applicant or Agent
Tarmac 0b6x.14050 Palm Desert CA
Name of Applicant (Please print) Business Address f Telephone No. .
'f ..
on file
%
Name of Contractor and Job Foreman ; Y' ti Business Address, r Telephone No.
r on file 4' % f• ., on' ,file i f
Contractor's License No.' ,; 4 4 1 +. - City Business License No. w�
I
-Applicant's Insurance Company b, t ,f1 .,1 Policy Number ` el
I
` ?
FEES:'-, Subdivision Improvement Permit — Class III
+- Public improvements: 3% of estimated construction costs 1046
r • �,�,• _
Private improvements: 3% of estimated construction.costs r
• • y ' Ir `Y ,.3 1 • f .> Minor Improvement Permit -Class IV: See attached schedule' a r
• yf y ! Inspection Fee $ `' ,�, -ji PERMIT VALIDATION
Permit Fee + -10,00 ` ; r" PERMIT N
} 0', 1046_ -
Penalty •3 t s•t
�.• ' i r rt Cash Deposit -Surety Bond r,_. YDATE APPROVED
t •.:I if required' ~EXPIRA DATE 4=
w ) TOTAL: -1-91
OAT ISS ED
t • I ` Receipt No.- ,
y as `I +i By s
;, r V + • + 7.ry Received by " ' Date • < %` A ministrative Authority,
+r t ;Recorded by I -TELEPHONE (619) 564.2246
s '