10837'' :'.' r � � �. � 1. a %;?jr •. . -t ` 1 _ ` ; � � ,,...
Y5.'fi I'' 'i 3 r-a.....,.P+l;��' FL, 'r. r .. .. .a'i L .tir..,a .,.. ........,%.�. `•ri. a,r....}i 'r _ ;.«..t. .
NOTE: / ..
With proper validation _
this form constitutes an..
encroachment permit CITY OF,., LA. QUINTA
APPLICATION FOR PERMIT
y
PUBLIC WORKS •CONSTRUCTION (ENCROACHMENT):
OVERSIZE,;LOAD PER)sTT ,OF
For the construction ,of public or private curbs, driveways,. pavements, sidewalks, parking lots,. sewers, .water! mains. `-
'. and other like public*.vvorks improvements in connection w. ith;MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision. Improvement Permit -Class 111
`DATE: April 26, 1991 Minor Improvement Permit Class -IV.
:. ; • move equipmen.f F.
.'LOCATION. OF CONSTRUCTION' �f
..(Street addressor Description of Location)
cat -. gr�ider -10' : wide
PURPOSE OF•CONSTRUCTION Sketch (attach construction plans -if app"ropriate)
;green weight, 'all -else • legal
R'
r."DESCRIPTION OF CONSTRUCTION' ;
HAUL'ROUTE: MONTERBYAAND ALVARADO''
' TO Avenue. 52 and out of Citp",aimit5 ,
5 : ✓,•DIMENSIO•N.OF INSTALLATION OR REMOVAL
Haul Date 4/26/91,
t':,.SIZE OF.EXCAVATION; I F.NEEDED `
:APPROXIMATE TIME WHEN,WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
:
ESTIMATED CONSTRUCTION COST $
r .:(Includind removal of all obstruction; materials, andAebris, backfilling, com
paction and: placing, permanent resurfacing and/or replacing improvements)
' :In, consideration of the granting of this permit, the 'applicant hereby agreeslto:
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 an accident, loss or damage to persons orproperty°
P 9 9 Y 9 P ' "
happening or occurring as a prokimate 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, withsall 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 a'.theresult of this work.
Ting G��e�;•
j Signature of'Applicant or Agent
r Tarmac/Massey' PO Box 14050 Palm'Desert;..CA:92255 -
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. ,
,, -Applicant's Insurance Company.. Policy Number
FEES:. Subdivision Improvement Permit - Class
Public improvements: 3% of_estimated construction costs
10:8 3
.Private- improvements: 3% of estimated construction costs
Minor,lmprovement Permit — Class IV: See attached''schedule '` F :• ; `
Inspection Fee $ PERMIT ,VALIDATION
Permit Fee %h' ' D+G/ 1083.
PERMIT NO.
f -.4/26/91.
Cash Deposit -Surety Bond . -'DATE APPROVED
if; required 4/26/91
�w t:" EXPIRATION DATE
TOTAL: $ +� DATEISSUED.... 4/26/91
'Receipt No. . r
BY
Received by DateAdministrative Authority
Recorded by
TELEPHONE: 619 564-2246 l )
TJ
0
A
Y ..
t
wi gib' N
NOTE: '
With proper, validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OVERSIZE LOAD PERETT
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
C
T
Subdivision Improvement Permit — Class I I I
DATE: April 26. 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION move equipment
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION cat
Breen weight. all else 1
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
10' wide
Sketch (attach construction plans if appropriate)
HAUL ROUTE: MONTERI6YAAND ALVARADO
TO Avenue 52 and out of City limits
Haul Date 4/26/91
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 undertakeni 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 f_rarog
Signature of Applicant or Agent
Tarmac/Massey PO Box 14050 Palm Desert, CA 92255
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.
r
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$
Receipt No.
Received by Date
Recorded by
1083
PERMIT VALIDATION
PERMIT NO. 1083
4/26/91
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
4/26/91
r.
By
Administrative Authority
4/26/91
TELEPHONE: (619) 564-2246
I
P_91 IL
— 2 6 9 1 F R
'APR _ � __ _ y!• "
+� r.. +ter ...� r� ��•. wrr a.�'+ed �orwrr++�w�'�'o�ws��...•w..r r:.r e:�►+lo riu rs.Allis
NOTE:
WMA Draw vellt:ata
n U , this form cone uft an i �''• y '
;;� ' AnCroedtngrtt oermlt _ ' ', CITY OF LA OUINTA
APPLICATIONFOR . PERMIT
*PUBLIC WORKS CON UCTION iENCROACNMENTD
PL , pariting iota, 1alwro. + fhaYltl • ' '
• Fqr that Comtruwgn Of b1i0 or P rrveta,t:urbs, driyewavi,' peren+orttA, lidalyalke ,�•
and other like PubliE wtl ke iii4 m$ In aannoeoon_with MINOR IMPROVEMENTS and APPROVED SU8f319/IStpV$
Subdivision trimm.trsnt P rt
• � � . ' DATE: - I ar1•r - Claae III d.�..,��,,,,,, '"', �•r, •:.
., �'[ �. Mirror Imdiovef•riorrt Pwm' Ctatal IV'
LOCATION QF CONSTRUCTION
I
(St►wt e0rlrata or owovw at Lommm t ' I
PURPOSE OF CONSTRUCTION Skstdi (attach:
RTIONOOW1i9rYRi0nQ/�ia�nA tQ Lpp�1.
O I�`OF �N5iRl1CTiCiN
DIMENSION OF INSTALLATION - , RF OVAL1
SIZE OF EXCAVATION, IF NEEDED
a74 ,
APPROXIMATE TIME VMEN WORK WILL BEGIN 1.[J// r /♦
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COS'T'S
i tinduding removed of all olsrtruc-ion, rrato alt, and dit", backfiffing, torn
paepon And plating ptnttantirrt r.aur(#ting and/or rtrpl anq imarovema"u)'
.,
In consideration of the g=Ting of that permtt„the applicant herov agreaa to: ”
InamntlY,'e.tere anti sew the City. to a+tnonad wMil. office", t.arntowretim enc wMiave", hermtemt from are sow= etty anti eN
paaatt»s, liabdttiat W lot ►ANtcny fmm aairm at MUM 00100 ane etamq ort of WN eMMM. Ims N '46MA s .10 jailci er paatawty •. '� '
' tter+MnrrN W .00currna as a pmawmaf ream" of WN vM** ufrrwtarrn uni*r tree Oernftt t♦nneea ourawn to pita awwotatt, �' ; t•'., '
NOUN the Aem.awkr ova Autttem apt boat rrwnvi Ivur 11241 Anure in wtsettr of the t+me wttan,won i twi be
�. COMOIY Mt•h all AOPLI0 M CAV 0,010 -mm, teff Ism, and Ot] 4 • paten e"+0 tit bmiwela sea ert0
t+at tOrr1 of of rt of d►a Catty
# .Lo Qwnta atw to OXY 1W aw worbotd repuewrtent neemowv et tfit nrw,lt of K want, t
signawl ko
t AttPttun or A cent ' ,
of t 1 ale arintl ustness Adtlrosa taleprtone No. r'+'
Name at Contractor anti Jctd ore #n ' Buttneu Addnss . . _ Tel No, - •!��t; ,
t OhUbetor's L,tanse No,
. .. �: itv 8uuneu lioanu a. ,
Aoct+rans'i Insunnoe Ceurwvly PolICp
- Number
FEES. . Subdivision imorowm m Parmrt —Class ill"
,,. Public imPMV01 arra: 3% of attnrtetad cometructioa coats
r Private lmprovetnertn: 3% of estimated comtrurtton toss N0
Minor Imoroytm"T Permit_ — Cuss IV: See atorpted sd+edula "` • _
lnccaetr4n F -e g,,� PERMIT VALIDATION {
peimtt
•°ERPRtT "O.
Cuh 09tsas,rSurety Bono - DATE APPROVED,
If houtr.d EXPIRATION DATE
TOTAL
tVo,
DA
TE ISSUED
' RaCwtpt '"i
Reostvea by Dana Admr„>sti AWfor}tY
r t � � - - - mwwrsT)F'I t; pa3Aane. aa•w, .�. _ - .,.. ..... .. •'�.