1062tl
r
4
A
I
NOTE. 'J
Wlih
,.proper validation
this form: constitutes an
I t
. I . i _ 1. - IUl T
CITY OF LA d N' A
encroachment permit
APPLICATION FOR PERMIT
PUBLIC. WORKS CONSTRUCTION' *(ENCROACHMENT),
OF
OVERSIZE , LOAD-PERMKT I -P THS f'
forthe construction of 'public or private curbs ways, pavernents,, sidewalks;'.pd ing lots, sewers w ter, mains
_4 driver�: a
'and other like public works improvements in connection with MINORIMPROVEMENTS and APPROVED SUBDIVISIONS
,April 16, 1991, Subdivision Improvement Permit -.Class III
1-', DAT Minor Improvement Permit-Class]v
move equipment'10dATIONOO� CONSTRUCTION
4 is (Street 'addresvor Description of Location)
barber,green,.paver.
'�ONSTRUCTION' 'Sketch (attach construction plans, if appe6priite),-
reen w igh tv all,else legal
Uu4pti ,
e e e
9
DEJCRIPTION.'OF CONSTRUCTION Haul Route: Washingtofi-�at Fred,
rWaring South to Eisenhower'
west to Fernando and north'
to J -bb
Sit' re' ,
verse- for.,return:
DIMENSION..=OF`INSTALLATION'OR REMOVAL .....................
/91 OE.RIP
DATE: 4/17/91 N,T
w. "t I r I or 4/18 _
ROUND ONLY
W,
"-'SIZE OFEXCAVATION IF NEEDED
"q
Y,4' —APPROXIMATE TIME.WHEN�WORK WILL BEGIN
Al5P0R X'*IM'ATE,TIME OF'CbMOLETIOW
1-'... 1, , T.
''ESTIM�ATED CONSTRUCTION, COST$
removal of all obstruction,, materials, and de6r'is; backfilling, com-
paction and,', placing. permanent resurfacing and/or replacing improvements)-
Im.consideration .of xhe.grantmg of this'perm,it, -66.1n S
applic� t hereby agree A0
4,i
'ierid and'sive the -_Cit'y:�'its authorized . ag'lahttis',' officers, 'representatives. an ny and,all
Indemnify d emp] oyees;'ha rm less from and.against a
_.�lfing from cl�aims,or."court a fl,.an� accide6f, loss .or to persons or property
-n 611- or loss res c ion and o S
it penalties, a I Itl
-a" undertaken,under the.p
-,,.,h ppening or occurring.as a proximate result of any ermit granted pursuant ' rsuant to this application.
hoursjn advance -
Notify, the Administrative Authority, at- least twenty-fouF (24)of 'the time when work will be started.
'C-
orriply.'.with,all applicable City OrdinaAces the ie'r ns'and c6ndition; of •'the permit and.all applicable rules and regulations -of the.City of
La Q 6i n*taand opay f or' a naditiona rep aceme,nt necessary,as the resultit of this work.
.4
j,-, T na,Gracey
;F�
tu or gent'
J, Sigha re'6f Appli6ant' A
tc C, int -'d'e'rt, X,'. 92260. Tarmac'/Massey 1, -Po It Bok 14050r, Pahl C
-'Narne of Applicant.(please print) 4,',Busin"ess-'Address Telephone No..,
f 1-1
Bu ne re
d �'.B si �s�Acld"�si.'
'Name of Contra- J'
Contractor an ob, Fi5r�d�n Telephoner No.
0
L
n on
.'file,
i -le,
7
.'Contractor's License No. 4City 't Business. License No.
—.
on';file eL
A��licani's'l nsurancii Company Policy Number
FEES:' Subdivision
Improvement Permit Class III -
Public improvements:.3% of estimated construction costs -`2
Private improvements: 3% of estimated construction costs D 6
Minor Improvement Permit —,Class IV: See ittached,schedule
In''spec + tion,Fee $ PERMIT .VALIDATION
l0000
P rmit , Fee PERMIT NO. -1062
Penalty
DATE APPROVED 4/1-6/91
ash Deposit -Surety Bond
it required
EXPIRATION DATE 4.41 8.44i;
TOTAL: $
Receipt.No'..
Received by, Date
Rk6rded by
� 4 ,
i�,°-.iii'�.*^,�✓_"�'y'""'�r`-�✓`%'..'1rF,�"ie�-1':'�`:-rti...�.i':.�..;re4 r.�--..atiEs"*.`-.:.� r...r.J•.... «. ,'4.'�..�. _ ,.:.: h_.-.� ........ �r-� ��:---+..-�. ��a��--: I^.�.�.'�f �. ..a h.. ^{ , .�
-__�._�.. .. __._ __,... .�_.– �,_ _-- � � _-�Y.___. ... _. .� —� _.---' -----_�.___�._ -� � �__� ....mac __. _�_
t
r `b� r ����, ry•�� S
NOTE:
With proper validation
this form constitutes an
encroachment permit
-
4
CITY OF LA QUINTA
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
April 16, 1991 Subdivision Improvement. Permit —Class I II
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION move equipment
(Street address or Description of Location)
barber green paver
PUi6QbS OF CONSTRUCTION Sketch (attach construction plans if appropriate);
wide, green weight, all.else legal
DESCRIPTION OF CONSTRUCTION
r Haul Route: Washington at Fred
Waring south to Eisenhower
west to Fernando and north to job.
DIMENSION,OF INSTALLATION OR REMOVAL site and reverse for return
DATE: 4/17/91 or 4/18/91 ONE TRIP
ROUND 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
i
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or propePty
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.
•f 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 additionalreplacement 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. "
on file
Name of Contractor and Job Foreman Business Address Telephone No.
on file- on file
i.Coonaq 'ss License No. City Business License No. _.
- I
Applicant's Insurance Company Policy Number
FEES.: -Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs + (� r� ,
Private improvements: 3% of estimated construction costs L C
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION 4
i
4
Permit Fee PERMIT NO..1062
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Receive6by" Date
Recorded by
DATE APPROVED 4/16/91
EXPIRATION DATE 4/18/91 i
4/16/91
DATE ISSUED /
By �
Administrative Authority
TELEPHONE: (619) 564-2246 ty
•
TUE 9 '.24 MAS
�7PR— i g--9 1 .�..
... wr..,s .w..,.....+o .,.. �•..i.�......r+--e.f..�-.r..®--p+r'--.►seer +.-r aw .l�...w►..,..
NOTE:
Wkh proper ventilations
this form tonatfeim an CITY -OF LA CUINTA
anemArrimAnt Vomit
APPLICATION FOR PERMIT
PUBWC WORKS CONSTRUCTION (ENCROACHMENT)
s For the coristrucaon of public or prnfats curbs, drivtwrays,,pavtmettts. sidevrefks, parking lots, aware, WnWrtiaisw.
And other ilk@ public works irrVMn"was in connection Wide MINOR IMPROVEMENTS and APPROVED SUBDIV1 j(ft
Subdirkion (►+orovermat Ptemrt —Ctw III
DATIe..".,r../ L!� Mltw ImprOWN ntent Permit am IV
LOCATION OF,CONMUCrON
(Susaf Wsom" or Onavoow at
PURPOSE OF CONSTRUCTION .._ - Skotdt (attuit oanst olon OW i4 a r;
lift,/J�n C�1�s✓®
I)PSCRIPTION OF CONST U N , r '� FP'! ;
Q S ,c it
DIME ON OF INSTAtLAI WN OR REMOV
SIZE OF EXCAVATION, IF NEEDED 0�4_D = %�gy�. � -
APPROXIMATETIMEVMENWORICWILL BECIN �% %� r F`�
T"'"fi_
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(including nmorel of all obianji don, matenels, and debris. backfilling, tom
pactson and placing pomunant rewrfeaN and/or replacing Impraae-neii I f
In Consideration of the granrlrig at this pernur. the applicant hereby agrees to:
I11d9mnitV, def94nd am 19ve the City, ft avoicolod &gams. Officers. tapr.aentetrow And Irnorareos, hsrttnaas from ata main aw and sit
DenutMs, liabdif6s or Mara nwlUne rw n Cieimr or toun WVon snit 9r0bp OQt of Any Wals"r, ion Or &mop fo salaam eR -"MWp
haDWV4 or OWW" of a pMAWriaq town of Any wwM w.dnwken under the Parotin panted punwMn" tlib wimics
Notify me Admtnnnnnim Aut wft As /ran tateorykour 1241 haun N aevene9 M %$ time when rows Will be vuirvsC
ComWv «.d+ ell .aaK9ae C1ty Qlainra+eaA, the thins wed O,naetton9 of the O"d ora) all aaofierbte tufa and torAirtMW ea elle Cin, al
L ZIA" 9100 W DN tvm shy aedmbNa teaamm9nt nraeW.v as 1"9 feait of IWO www.
c
S;gnasuffj SlAolstiaw or Agimt
1'
J
Nems at Aooi(eant (pleas+
Ouunats Address
Talwona:w No.
Name at Contramot an Jo} Foreman Business Address TAIA No.
Contractor's L.toft' io. ChV Binineaa Licents No.
Applicant's tnturana Camwy Policy Number
FEES, Subdivision Imonrrem"tPerma—Clan 111
Public improvernertts; 3% of or nested construction costs
Private irnororemarrts: 3% of emniatea oonfrtru=on costs l� O
Minor improvement permit w Class IV, Sea artactiod schedule e
inspenjon Fee
Permit Fee
Penalty
Cash Deoosit•Surety Bond
if ttoulted
TOTAL;
ftewipt No.
Racswea by Dan,_ .....,..
PERMIT VALIDATION
vr.qml,r NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Adntinaa'etrvm Autf+�.� '