1070~ `NOTE:., ,v .
With proper validation}
this formconstitutesan
encroachment permit CITY!•OF•• LA QUINTA
APPLICATION. FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) _•,,.: ��
oF TAB�wsw
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: 4-23891 ~ Minor Improvement Permit Class IV
"LOCATION OF,CONSTRUCTION
'`IStreet address or Description of Location) w '
PURPOSE OF CONSTRUCTION, Sketch (attach construction plans if appropriate)
Route; Madero and Montezuma to
k DESCRIPTION OF CONSTRUCTION.C,Rnanag ArnriAr Nogales to Eisenhower to 52nd out of Ci
'V6" 'Wide teen 'wa1'ght all at as 1 agaI City limits
-,DIMENSION OF INSTALLATION OR REMOVAL
Date 4-23-91 .�".
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 placingpermanent resurfacing and/or replacing improvements)
- • In consideration of the granting of this permit, the 'applicant'hereby• agrees to: a
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,occurrin as a proximate result of an work,undertaken under the ermit' ranted
pp g g p y e p g ,pursuant to this application.
4 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
r , xaimac /.`Massey,P.0. rBOx' 14050 Palm Ddaart
^• bName of Applicant(please'print) Business Address Telephone No.
Name 'of Contractor and Job Foreman. Business Address Telephone No.''
onf i a `. q on file
Contractor's License No. City Business License'N_o.
6n. e -
Applicant's lnsur`ance-Company , Policy Number
"FEES: ':Subdivision Improvement Permit — Class III '
Public improvements;,3% of estimated construction costs _ 070 -� 0
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10.00 PERMIT NO. 1070
Pen§tly 4-23-91
Cash Deposit -Surety Bond DATE APPROVED
4-23-91
if.required
EXPIRATION DATE
TOTAL: $ 1 n,4no DATI B ED =23-91
Receipt No. B_
Received by Date dministrative Authority
Recorded by TELEPHONE: (619) 564-2246
f. .: �, _ , :: v:•' ., f...i' Q.`.'T �.... r' `" .. � 4S-w�, _ �.�.. .. _. ..,� w _ ,.. �"+-x . •?o.,,,•a+.r. .,..ti, .t `/
FE
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NOTE::
With proper validation'
this form constitutes an
encroachment permit
a
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
'-'4-23091 '4-23091
->DATEt • ". 'Minor Improvement Permit Class IV
.; ..: LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE'OF CONSTRUCTION Sketch (attach construction plans if appropriate)
- -- Route; Madero and Kontez' to
DESCRFPTION OF CONSTRUCTION Romag (;rinrlar Nogales to Eisenhower to 52nd -out of Ci
9°6" wide green weight all p1AA lAgal City limits
" DIMENSION OF INSTALLATION OR REMOVAL
Date 4-23-91
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. persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
b Notify "the Administrative Authority at least twenty-four. (24) hours in advance of the time when workwill 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`/"Massey. P.O. BOX 14050:Palm Desert
Name of Applicant (please print) . Business Address. Telephone No.
Name of Contractor. and Job Foreman Business Address Telephone No.
o
on file
nf ile
Contractor's License No. City. Business License No.
on, likie
Applicant's Insurance Company Policy Number
FEES -.,Subdivision Improvement Permit —Class III '
Public:improvements: 3% of estimated construction costs _ �' O"�
r Private improvements: 3% of estimated construction costs .•
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10.00 PERMIT NO. 1070
Pengly
Cash Deposit -Surety Bond
if..required
TOTAL:
Receipt No.
-Received by
$ 10100 <',.,Ff,; •, r,
Date
DATE APPROVED
4-23-91
EXPIRATION DATE
., i 'Sar. f,,,i-•'^
DATE I S ED s-23=91
By
NAdministrative Authority
Recorded by �' TELEPHONE: (619) 564-2246 ��ll
. �N�: kYeii � .tii.:*^i P�'•c�ty,.ra��. . .La. r�P: ,�.`., - -
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NOTE:
Y
With proper validation •'}l
' •
F . iY
this form constitutes an
CITY' OF LA`�QUINTA' c.
_
encroachment -permit
_ APPLICATION FOR PERMIT,
• •F `
f� , PUBLIC WORKS CONSTRUCTION .(ENCROACHMENT) , a�
/
•• r
For the construction of public , or 'private curbs, driveways; pavementssidewalks,'parking lots, sewers, water mains '
- r •
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
., Subdivision Improvement Permit —.Class III
DATE: 4-23=91 ► r Minor Improvement Permit Class IV
'LOCATIONOFCONSTRUCTION ' �` f •`+..' `
]
` ' :
y. f - yak . � t• �, ' . , •
,
Y
1 (Street address or Description of Location) n •
I
PURPOSE OF CONSTRUCTION {'' Sketch (attach construction plans if appropriate)
t -
_ ,, Route;.Madero and.Montezuma'to.
'Gri
s
DESCRIPTION OF CONSTRUCTION Rnma nAur '
g _ to Eisenhower' to 52nd out of
_.Nogales
9t6" wide green weight a11. Plea 1'ognI City limits w -
r
-r *7
-•
..
3 DIMENSION OF INSTALLATION OR REMOVAL
`Date
4-23-91
SIZE OF EXCAVATION, IF NEEDED,
•i - s. .
-.
APPROXIMATE TIME WHEN WORK WILL BEGIN', " - •-. o�^•: -_ ' -
' •`•
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)ef
ily
In consideration,of the granting of.this permit; the applicant•hereby. agrees to:
• •-
_ Indemnify„defend and save the City, its authorized':a :agents, officers representatives and employees harmless from and a♦sins[ an and all
9 P , 9 V
• _ • ,�
{T”
- ,, "perialues liabilities or loss resulting from claims or court action 'and arising out of'any, accident, loss or.damage to persons or property
j
-` •' ' '�, -
44 happening or_occurring as'a proximate result of any work undertaken' under the permit granted pursuant to this application
•.
,.
h
.Notify the Administrative'Authcrity at least twenty-four_(24) hours in advance of the time when work will be started.
` • , - .t Y . • '''" ',
• Comply with all applicable City Ordinances, the terms 'and, conditions ,of -the permit and all applicable rules and regulations of the City of =�}•
+t y
_ '•
La Quints and to pay `for any additional replacement necessary, as the result "of this work.'"" i
01
; r i `F• Signature of Applicant or Agent 4 -
r.
` Tarmac / Massey -Desert '•'�
s'
P.O. Box 14050 Palm +
i
'
Name of Applicant (please.print) r• ' . Business Address' ` - Telephone No.
.
F- i..
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- •7
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Name of Contractor and Job Foreman + Business Address, Telephone No. y.
;•1,�.
• r.g
onfile• .� ° :on file i
'Contractor's License No. City Business License No.. i
` on filer
•
Applicant's Insurance Company , f' Policy Number
FEES: Subdivision Improvement Permit =Class I11; , �• A
t ► ,;
- Public improvements: 3% of estimated construction costs , hO 70
t:
Private improvement's: 3% of estimated construction costs
. '.
Minor, Improvement �Permit - Class IV: See attached schedule,.
`+
=Inspection Fee '+ $ R
i PERMIT VALIDATION
Permit Fee
,;' •
PERMIT NO. 1070
t z r
Pen�ty , ,..
4-23-91
� .:. ••
w
'
j Cash Deposit-Surety,:Boncl
DATE APPROVED.
if required r �' r
EXPIRATION DATE 4-23-91
}�
TOTAL: $ in _ nn4=23-91
DATE ISSUED
_
t
Received by .Date
t.F
By
"r ! Administrative Authority
..°
Recorded by
TELEPHONE: .(619) 564-2246 `
,
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REMOTE STATION I. D,'
START TIME• ,
'DURATION
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-DOCUMENT, '
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CITY., OF L'A QUI NTA
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encroachment pormlt
APP L!'GATION ''FOR •PERMIT'-`
�'- -t'PUSILIC
!,�•^ "
t + WORKS"CONHTRUC_TION (BNCROACMMBNT)
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Por the oon.truatlon o/'publla pr(yat. ou ro.,'�drlyoW.V.. pnv¢manta, .1dwalolka, parking 1p ., .paler., —over main f•
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and other lik. pubilo works Imprpyement.-In oonn.aRion with MI WOR IMPROVBMHNTS and APPROVED, 6UO DIVISIONS r
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Minor Imprpvaman< Parmh Clou I V tt
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LOCATION OF CONSTRUCTION -
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PURPOBH OF-CON8TRUCTION ^� (.trach oonatrU otlpnplan. If apOroprle! lY '
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h ducat btadpeo m,nd Men eornumA to
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DCSCRIPTION OP CONSTRUCTION _
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DIMENSION OP INSTALLATION OR R@MOVAL -
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APPROXIMATE TIMO WNSW WORK WILL BEGIN f r I
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- APPROXIMATE T1ME'OF COMPLETION'' Y
S8TIMATBO CONSTRUCTION COST S f"
(Inpluding ro movol 01 .11 ober., orlon, mat.,rlrl.; and'dobris. baakfllling. *m-
Paotlon andplwalnp p.rmanen<�ro.uNoalnp endlgr r.plu Oing Improvamwnte) I
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in aon.ld•rotlon of the granting of th le. pOtmlt,'the ¢pplioan2' hor.by epr.oe apx t 4 M\ . A
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NO\Ity, H•. Atlminittretlw Au[hgrley et lewtt r n[t•-/au x'1191 hour. In .tly . W tha time, vm.n v.Ork �wlll ba KeMtl • '
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Te<ztefal / Mnnn Bv_ 13.0_. Hn_se 1.6tl30 P 1 r1' _' i•
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N.me of Appitvant (plan O Printl -- - ,-+� ti j Telephone No.
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N.ma of Conveetpr and Job'Paraman - - 8-1ri . Addro.. , t T.IaphoM No.
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APnI PollO NU bel
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P888x Improvan•I.nt Psrmll—Cle.s 1l1�_;'' f• 1: d t t -
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P'l—t Imprevamont.: 8% of O.tli t e
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+ • Privet. Improvam.ntax 3% of ..ti mat.d oanavuotlon oai.l. � 7 � r
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r PERMIT VALIDATION
Parml. Pao f• :k _ t R nQ I
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PfdRMIT NO: '1070
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Pan40ty ^ - .. _
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4-23-91
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- Ca.h Owpn.it 6ur.<y Bond ,
DATE APPROV@D
1.
If ropu1re0 Y - .',.
% EXPIRATION OATH 4-23-91
;
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DATA "1
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'Reaolpt No.
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TBLBPNONE, (BID} 804-2946 • '
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START TIME• ,
'DURATION
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-DOCUMENT, '
(REDU.CED
SAMPLE'e ABOVE) . �.. ,.. .
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-#PAGES '
COMMENT
XEROX TELECOPIER 70.20
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NOTE:
WII► R MRW "IW@tkw
this foRn atseatraua an CITY OFLA QUINTA
anemicnmant dermrt
APPLICATION FOR PERMIT
PUBLIC WORKS CONiSTRUCTtON (ENCROACHMENT)
For tna Constmmon of putwk ar prtvua c"a"ts. drivewws. pavarnenes, sidewalks, parking loft, tewera, wauttr mama•,
Ind other like pt is worts lmom"onwrr:s in cwtneeaon wide MINOR IMPROVEMENTS and APPROVED SUBDIVISKM
�' Subdivision len
OATE:__a�.�orowmerrt P.rmat •.w, w,
Minor IMPVadrrtarrt Prrtnk'Cfrsj'I.V -;—
LOCATION OF CONSTRUCTION
\ ,
ISOM soonw or Casattmea of t.a®um,
PURPOSE OF CONSTRUCTION Sk4cm (ettach eonmuc%ion plat""* i4 �
002P r)ON OF CO -TAUCnON4^24124� � 1 t'x j4l7e 7" �
t� #�
01MEN410N OF INSTALLATI N OR REMOVAL1 /'1 f ? "' Wit-' �p
/` ftewPj
w4LE pF LAY-AVA I ION, IF NEEDED
APPROXIMATE TIME WEN WORK WILL BEGIN
APPROXIMA7E TIME OF COMPLE71ON
ESTIMATED CONSTAUCTION COST 3
tltxduding romorei of all obatrueawn, metertaia, and debris. btgtfiliing, Wtrr.� • -t - 60paetran and placing permanent rewrtsomg anWor fepiocinq imaroye erml -•L
In Wnsidermton of the gnnting of this Qermtt. tht applicant hertav aq►sos to:
Indemnity, Cat.nd and " the Cita, in avtnonaad s"nrt. offio n, norenlrtootwo aro anviovtel, herrnNv troll w" sown era and ail
94041100%. 1190414041 or Wd rdsuttwq "tear" Clatim or C54r1 Mloft arae aroma Out Of any W.4am, tors or 4awav to aer'aona or ta+omly .
nooftn'na br eon#"* a8 a vmxwmte null of any work mftdwaw uraw dee Do 1 -1 svntoo pw"WR to thir move"".
Notify the Ad"fiounne Autrto rw at Men trwnw-#our t24l News w ed.enaa of the time w" worn enll be vtwmrl.
CaneiY VA0 All aeaaeia Ciey O,tlov.. the t#WM end mntltwrte of the Dental nod all iowicewe rutav ena metra Wadof cite C7ty of
U Aulnn am to aav tri erw • adwrinw rat 4warr m naoalaw of the eewlt of worn. f • . ,
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of Apptaxnt at
Name at Aoauant 10 w Ottntl Business Address Telewww No.
Name of Contractor a to Foreman 8usmsu Andress Te o r Ne,
_.RFs , -- c��t ♦�F>
Contractart L•cante8 No: Ci u i
/' ty x Mss Liesnu No.
Apoucant's Insurance Con aairy Policy Numaer
FEES: Subdivision imor*wm@M PVMrt-C1su III -
Public imttrovemertts: 3% of kwwmted donetruetlon cats
Privem miprovatnents: 3% Of emmated conrtruction east"
Minor trnorovement Permit - Clan IV: See 4vacned schodute
inaction Fee S M PERMIT VALIDATION
Pertnii Fee
Penalty
Cash Oeoorn•Surety hand
if ►aauiren -
TOTAL:
Retreat No.
iieaored by Data_,._e�\_..,.
Raoorroed by
.tit.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED ='
-i
Admmtiraravw Autlwrrty � ; � . . ,
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