1068i
NOTE: T
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
r I'4� 9 91 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV'
" LOCATION OF CONSTRUCTION
,, ., � .� - � ;•� - ' 11 .
(Street address or Description of Location) '
CAT GRINDER 9'6*'LEGAL'HZ a
PURLPL F&ftT5� JEJft,N Sketch (attach construction plans if appropriate)
' DESCRIPTION'OFtCONSTRUCTION ROUTE; 52ND AT JT FFERSON WEST
WEST TO• DURANGO, dN TO MADERO -
SOUTH, TQ'MANTEZUK4
DIMENSION OF INSTALLATION OR REMOVAL
4 DATE 4-X22-91=
SIZE OF EXCAVATION,.IF NEEDEDT
`APPROXIMATE TIME WHEN WORK WILL BEGIN s R
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 per sons.or•property
happening or-occurring.as a proximate result of any work undertaken'unde'r 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 bewstarted. y.
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 / MASSEY.'P.O.-BOX 14050 PALM DESERT -
., 1• .4
Name of Applicant (please print) Business Address Telephone No. • ►
ON 'FILE
Name of Contractor and Job Foreman Business Address Telephone No. .
`
'ON 'FIRE-ONFILE
Contractor's License No. City Business License No. fi
ON FILE
Applicant's Insurance Company Policy.Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction. costs"1-0-U 8. '
t
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule r
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10.00 PERMIT NO. 1068
Penalty _ _
G r Cash Deposit -Surety Bond DATE APPROVED 44-122991
if, required EXPIRATION DACE
TOTAL: $ 10.00 D EIS UE / 4-19-91
Receipt No.
BY
Received by Date Administrative Authority
R
Recorded by TELEPHONE: (619) 564-2246
A
% J t
NOTE
With proper validation
this form constitutes an
encroachment permit
.r
f
CITY OF 'LA QUINTA
APPLICATION FORS -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: ,..�; 19-91 Minor Improvement Permit Class IV'
LOCATION'OF CONSTRUCTION
(Street addressor Description of Location)
� R CAT GRINDER 9'6°.LEGAL AI
P 13,W -p F&&W j WjaiGNi Sketch (attach construction plans if appropriate)
DESCRIPTION OF,CONSTRUCTION ROUTE; 52ND AT JEFFERSON WEST
WEST TO DURANGO ON TO MADERO
SOUTH TO MONTEZUMA
DIMENSION 0 INSTALLATION R
E N F INSTALLA 10 O REMOVAL
O A
L
SIZE OF EXCAVATION, IF NEEDED DATE 4-22-91 s
APPROXIMATE'TIME WHEN WORK WILL BEGIN ti
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstr.uction,. 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:
hndemnify,•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..-' 4
Signature of Applicant or Agent
TARMAC ./ MASSEY P.O. BOX 14050 PALM'DE,SERT
Name of Applicant (please print) Business Address Telephone No.
ON FILE
Name of Contractor and Job Foreman Business Address Telephone No.
ON FIRE ONFILE,
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
1.0 6 8
Private improvements: 3% of estimated construction costs
Minor Improvement -Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
10.00 1068 :r
Permit Fee PERMIT NO.
;;. Penalty
Cash Deposit -Surety Bond
if., required
10.00
TOTAL: $
Receipt No.
Received by Date
Recorded by
R
DATE APPROVED 4— 19-91
4- 22-91
EXPIRATION DA !En
KSS , .$':•`.�.?
DA E IT S IIED // _ 4-19-91
By .
Administrative Authority
i
TELEPHONE: (619) 564-2246
:...,.,
R I
14 :50 MAS
APR — 1 9-9 1 F .�.,
1v Y !� �,� ru„ 1� r.,�• lW.tr�.r�..�ill�i�•�1��i•�t��Yl►ir�vsr `O RY��•`F
.h
0:
NOTE:
With prow validnw&
this form oorlttrumn an CITY OF LA QUINTA
entS0a6hment OMnR
APPLICATION FOR. PERMIT
PUSUC WORKS CONST UCt"ION (ENCROACHMENT)
For the conun=an of pubiio or prnraba curies. driveways, tswvame+rta, sidewalks, Parking lots, uwate. Mow fhfiw,
and Omer like Public woks imw0eernalnft In connactron with MINOR IMPROVEMENTS and APPROVED SUBDIVISIOM
t Subdivision Improvement Purism — 64i'1111....�.�.
DATE. minor Imp ultrnem PVrmit 0&Ij iV
LOCATION OF CONSTRUCTION
d• r f
Imes soma or Qw>rt+voow of Law Maws
PURPOSE OF CONSMUCTTON Skauh (antc h eanetruction pwrsi if 4witirftI J
DE R �iON 0 CO�ISTRuCrIO Ole , pf
I
o �NSI N Fo a INSTAILATt aR REMOVAL
!'C7
SIZE OF EXCAVATION, IF NEEDED — — � file-
af�- tr
APPAOXIMATE TIME WHEN WORK MOLL BEGIN /., � �P � A, ow
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
!Including removal of sit ohtt►uetion, rnatartsW and dab►r1t, backfilllnq, car* DO
paction and placing pe mairient r surfacing and/or replacing improvenowM)
In Consideration of the granting of shit permit, the applicant hereby agrMn to:
Indtnmdv, 4ofew ave a" ou Gtv, m suo+onsad 6"rm, cMkran. mommnolt" end w"wve+e, bwtmaw fmm as aem aw"au
pwoltua. !laminin or Ier1 mw Pum horn clam" at court eq,on abw arq" as of any iiwa t, lost at awheeo to 0arM or pla"101
h>o$, (he or ooturraq a e Orwrrrvai Main of Hcy waw wituout n ueaa the 0wrmn gamed puh.wnt to *is wiplexaft
Notify the Adwrosmo trtrM AweWW to )awt twentraow 1341 hWM a wiw~ Of tM Imm Whvft Yowl vnll be wanes.
WOW "In all a004e rose ciry 04rneaa. tis+ tNnn Ihd opndlnerw of tta W%tq aid all eaOlawW nrlao neeuutteni 10t.1% Stv of ,
Lr Quints arw to DW roc ow aetl vW* ratweam"Por ft +wwry ea the r wo Ot d,n v+em.
Name of Acoueant Iplaate a,rttl% �% 9ustnivis Addreat Tetannaw No,
Name ar Comraaor Ina ,lob ►e an flus+neu Addrets Toi roto o,
Contnctovi; L,canu No. City $uuneis License No.
zer ,
A00scant's Insurance Comvany Policy Numosr
FEES: Subdivwion ImOrprrs+ant PermR Cuss I!!
Public imprpvtmsnn1 3% of est:mnrd cunetrvctlon coxa
Private irnprovemams: 3% at etalneted ponstructlon wets 1� O
Minor Improvement permit Class IV; Seo sttaceed sehedute 111 a
Inspection Fee
permit Fee
Penalty
Gbh 04MIXSurety Band
It raoulred
TOTAL:
Rtte,pt No.
14"W00 by ._.
O3te —
PERMIT VALIDATION
"ERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED - r
Adeanottravw Audwir