1051NOTE:
With proper validation
this form constitutes an
encroachment permit
FrOr
f . I i yL��
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
AiTJOIC
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
April 8, 1991
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION nwe ec�uj ent
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 966 loader
15' �*h. 10' wide, green wleiaht
DESCRIPTION OF CONSTRUCTION,
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HAUL ROUTE: %MSH7NGMN AND FRED
4iWMG SOUTH TO AVE. 52 AND WEST TO
EISENHOWER TO NOGATM AND TO VA=10
HAUL DATE: 4/9/91 or 4/10/91 -
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.
f ,
Tina Gracey
Signature of Applicant or Agent
Tarmac/Massey 'PO Box 14050 Palm Desert, CA 92265
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
m • file
Contractor's License No.
on file
on file
City Business License No.
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
A
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.0(1
Receipt No.
Received by Date
PERMIT NO
1051
PERMIT VALIDATION
1051
DATE APPROVED 4/8/91
EXPIRATION DATE
4/10/91
DATE ISSUED 4JR191
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
10
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NOTE:
With proper validation
this form constitutes an
encroachment permit
A •tu•
CITY OF LA QUINTA
APPLICATION FOR PERMIT I%,_
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
• 25 V• • N 5N • 01•r
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 I I I
DATE: ril 8, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION move egUpnent
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 966 loader Sketch (attach construction plans if appropriate)
.15'.'h. 10' wider ctrem weight HAUL ROS: VPZMGICN AND FRED
DESCRIPTION OF CONSTRUCTION MRIIJG SOUTH 70 AVE. 52 AND WEST TO
ETSEN1f0WER TD NOGALES AND TO VALLE O
DIMENSION OF INSTALLATION OR REMOVAL HAM DATE: 4/9/91 or 4/10/91
ONE DAY ONLY
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 Boat 14050 Pa]m Desert, CA 92265
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
1051
PERMIT VALIDATION
1051
PERMIT NO.
DATE APPROVED 4/8/91
EXPIRATION DATE 4/10/91
DATE ISSUED 4/8/91
By
v�
Administrative Authority
TELEPHONE: (619) 564-2246
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NOTE: Y.t
With propel velidatil as. s.
chis roan conscrstrc>sa an CITY OF LA QUINTA
entroadimont tlermR •
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs. driveways, pavements, sidewalks, parking lots, uv Rall, water ?mk*
arrd other tike public works irnprCtvertt no In oonnaWan wilt MINOR IMPROVEMENTS and APPROVED SUBDIVISION
I
Subdivhian Imlarovon*m Permit — cIM III :r
DATE Minix Impevvarnant Ptrmit Ctasa IV '
---•�
LOCATION OF CONSTRUCTION ,
SStreet eddnei ar OatsrwRan v! toaatsdn► , ,,
i'
PURPOSE OF CONSTRUCTION Sketch (otasset as Mal n glee ' a f
0 PrT1O OF CODNSTpu= 74 Gt/ �l �Gl L°.' fQ S ir1�
v" /
DIMENSION OF INSTALLATION OR RCMOVAL
SIZE OF EXCAVATION, IF NEEDED Mar Ar
APPROXIMATE TIME WHEN WORK WILL BEGIN /d e)a h����
APPROXIMATE TIME OF COMPLETION ,
ESTIMATED CONST RUCnON COSTS �� '% 0,/' • /1/-4G
(Including removal of all ohattuation, mmeneis, and debris, tNcitfilling, conn
Deccan and placing permanent resurfaoWq and/or, replacing lmurousrr nts) . '-'0'
.� tm.�..._......_ .
In connideration of the granting of this permit, the applicant hcrebV agrees to: — Of -
I1nd4rfmitV, aafatw ate* Tare the City, to autftorntati agents. O icM. raonraamemna end sm0ioveea. hamdaes from and q.er sm Mat all
pattantas. ItabNidea or ton f mitnig ham aattem or eatirt action 4" Mattq out at anV w9stlem. lass of tame" to awfoom of W�xft'tv
n4aw"Ing or owyrn" as 4 Oroamnete MWK of asst work unawwiltan unw Ott 0~ Ilm"trd porwant to thm wwkxuwt.
NotltV the Aamtnrotretre4 Auetomy at ion twenty?our 1141 hdutt its advw%u Of the time Y^" wank wilt be natr"IL '
Cotaoty seat ell aaotwwo c4ty Oed4rorrott, the tense aad mnntitaons of tn4 0"" Vitt all sow ki"o rulea
LA Ciu(nm and to av for low oddi j*W twismO r ant n4aaaa V Oa the Nw+t oythle wore. w a
Name at AOpncant ipleate:rint)
S;4natura "pijcanW Agent
Business Address
+ngtwtmv of the ally of
Ne.
Name at Contractor ane b Foramen Busineu Address Tele No,
109'e7; Ae "z
Contractors L,censoPa. CitV (business License No.
Aoautant's Insurance Conmmv ^— — Policy Numoet
FEES, Subdlyluan lmoravvow t Parvus — Class Ili
Public improwmetral: 3% of es$rnwft Conatmetion COM
Private tmortwomance: 3% of ""meted construction cont Q
Minor improvement Ptrt'mt — Class IV: See atmated schedule
I
inspection Fee 5
hrmK Fee
Penalty
Cath a400sit•Sursty Bond
it required
TOTAL: S _ �.._. ... ..
Recs,ps No.
Reatved bV 04ts
PERMIT VALIDATION
25RMIT'.0..,._._ _
0
DATE APPROVED
EXPIRATION PATE
DATE ISSUED
By