1095-A
!' r
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT _
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)��
` OP
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
$-2-91 ' .
DATE: �. Minor Improvement Permit Class IV'
LOCATION OF CONSTRUCTION '
(Street address or Description of Location) ,
PURPOSE OF CONSTRUCTION Sketch (aitacli construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION BOMQG GRINDER 10' WIDE ROM WASHINGTON, 1,,111 SOUTH T0: 52
-GREEN W^.ALL ELSE .LEGAL TO SERMDDES TO 41011IMMM TO AI,VARADO
DIMENSION OF INSTALLATION OR REMOVAL v ,
' 'DAA 5-2--91
SIZE OF EXCAVATION, IF.NEEDED. t
N.APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION ;
_ ESTIMATED CONSTRUCTION COST $ a 3
.(Including. removal, of all obstruction, materials,'and debris, backfilling, com : + t ,• r;'
` paction and placing permanentresurfacing and/or replacing improvements)
�+{ lin 1.consideration•of the granting of"'tliis permit, the applicant .hereby agrees to:
Indemnify,'defend•and"save the City, its authorized agents, officers, representatives and employees, harmless from and agairist any.and all
penalties, liabilities or lois 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.
F. Notify the, Administrative Authority at' least, twenty-four (24)J hours in advance ofthe 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 - - v r •• G - , • t � ,tee: . :G ..]
Signature of Applicant orAgent _ • .
MASSEY/TAM&C'P.O..BOX 14050 PALM DESIRT CA 92255 =
Name of Applicant (please print) _ Business Address Telephone No.
ON DILE -
Name of Contractor and Job Foreman Business Address ,Telephone No.
ON I=t r .ON FILE . a
Contractor's License No. s City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public im,provements`. 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
Recorded by
10.00
$ 10.00
Date
PERMIT VALIDATION
PERMIT NO. 1095
DATE APPROVED 5-2-91
EXPIRe ION DAT) 5-2-91
rAD TE p / 5-2-91
By
Administrative Authority
TELEPHONE: (619) 564-2246
MNOTf: ' ,\Z_
With proper validation
this form constitutes an CITY OF LA QUINTA:
encroachment permit
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 1.11
DATE:—? -91 Minor. Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location) _
`PURPOSE OF CONSTRUCTION Sketch (attach construction plans ifYappropriate)"
;DESCRIPTION OF CONSTRUCTION BOMAG GRINDER 10' WIDE y ROUTE WASHINGTON 5111 SOUTH TO,"52.
GREEN WT` ALL ELSE : LEGAL TO BEBMUDSS, TO TO. A VARADO r T
DIMENSION OF INSTALLATION OR REMOVAL
DATE 5-1-91 '; t
SIZE OF EXCAVATION, IF NEEDED
r t+APPROXIMATE TIME -WHEN WORK WILL.BEGIN
APPROXIMATE TIME OF -COMPLETION `
f . ESTIMATED CONSTRUCTION COST $
(Incl'uding 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:.,
:. 1,ndemnify,;•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 tofpersons or -property r;
•happening or occurring as•,a proximate result.of any work undertaken under the permit granted pursuant to this application.
Notify. the.Adrriinistraiive 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'C.ity,of
La Quinta and to:'pay for any additional replacement'necessary.;as the result of this work. "t
` Signature of Applicant or. Agent .
;' ` MASSEY/TAa�IAC` P.O.
'BOX 1.4050. PALM DESERT CA 92255 -�
Nam"f Applicant (please print) Business Address Telephone No. ,
t:. ON FIy.E
'Name of Contractor and Job Foreman Business `Address Telephone No.
ON I= ON FM
--Contractor's License No. City Business License No.
it x .
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 0
95
Minor Improvement Permit — Class IV: See attached schedule .
-Inspection Fee $ PERMIT VALIDATION
Permit Fee 10.00. 1095
PERMIT NO.
Penalty 5-2-91
Cash Deposit -Surety Bond DATE APPROVED
if. required 5-2-91 '
Ti DAT
$ 5 —91
10.00 uy.,,i,,i• ;� ��/'
M�.. —2
TOTAL: ti W!, } !
DATE bSS ED
Receipt No. ~
By A
Received by Date Administrative Authority,
Recorded by t TELEPHONE: (619).564-2246
pl A
.NOTE: a
_
With proper validation
F • '
this form constitutes an .
CITY. OF LA QUINTA
' • F
encroachment permit •
APPLICATION FOR PERMIT
83
PUBLIC WORKS CONSTRUCTION •(ENCROACHMENT)
OP rFIB°w
For, the construction of publicY or' private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
s
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
•'` •
- Lt J r Subdivisiori Improvement Permit -Class III"
`5-2-91' ^r
DATE -,� `f Minor Improvement Permit Class IV .
LOCATION OF CONSTRUCTION
r
- •4�` -
•
' • (Street address or Description of Location) • r'
1
PURPOSE OF CONSTRUCTION ` Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION, BOMAG GRINDER 10' WIDE ROUTE WASHINGTON 6 ,111 SOUTH TO 52
,GREEN WT ALL ELSE LEGAL' + JO BERMUDAS TO KONTHREY TO ALVARADO
a,
DIMENSION OF INSTALLATION OR REMOVAL ". -,. , • a V_
'-
-
+ '• f •* � .. - .', ria.
- ••
r k -t ,r ..
•.s DATE 5-2-9l"
- '• +
SIZE OF EXCAVATION,.IF NEEDED,'
..
APPROXIMATE TIME WHEN WORK WILL BEGIN
4.
►
'APPROXIMATE TIMEOFCOMPLETION
,
ESTIMATED CONSTRUCTION COST $ - 's_•
(Including removal of all obstruction, materials, and debris, backfilling, com• '
paction and placing permanent resurfacing and/or replacing improvements)
In consideretion.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.
-''
- - •, u Notify the Administrative Authority at lean twenty-four,(24) hours -in advance of the time when work will be started.' .'0
.:. `t.
Comply with all applicable City Ordinances, the terms and -conditions of the permit and all applicable rules and regulations of the City of
Le QLinta and to pay for any additional replacement necessary as the result of this work. .'.
'�
;; t'r�- N
• -
j ' ` Signature of Applicant or Agent
•
MASSEY/TABKAC P.O. BO%'•14050 PALK.DESERT CA 92255
Name. of Applicant (please print) ^� *. Business+Address Telephone No.
..
ON FILE
^'
Name of Contractor and Job Foreman, „ •' Business Address Telephone No.
t~
•.
ON FILE ON. FILE
'
Contractor's License No. City Business License No.
•« n •
...i - •.� _
,r !Applicant's Insurance Company ' w, •_ Policy Number, - ,• ,
FEES: • Subdivision Improvement Permit'- Class I I I' 4
-
- Public improvements: 3% of estimated construction costs
�.. 1095-' r
Private improvements: 3% of estimated construction costs
` „ r
3 : ' -
• Minor Improvement Permit - Class IV: See attached schedule
r
•,
r "Inspection Fee -'s
PERMIT VALIDATION
•
Y
° , Permit Fee 10.00 ; ?"
; i
1095 t
�.
PERMIT NO.
.
- i • Penalty •
DATE APPROVED 5-2-91
" C :
z '
Cash Deposit -Surety Bond t j
-
if required
5-2-91
EXPI ON DAT
TOTAL: $ 10.00 r
TE M
}
Receipt No.
''#
',
•
i Received by Date
,Administrative Authority
Recorded by {
..
TELEPHONE: (619) 564.2246,
Y —9 1 THU
MA — .• ,r•. r r� ��
NOTF: '
Wkh oeepsr veiIAetaeer
this form caro tt n" an CITY OF LA OUINTA►
Inrrooemm"rrt oOrrnrt
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION IINCROACI'IMENT!
'
For the construction of pubUC or prrvate euft, drivav4va, pavamrM. aidaweiko, perking iota, aewrara, vo too romltee.
and ocher like public works 6rnjut" n e . In eonneimion with MINDR'IMPROVEMENTS end APPROVED SUBDIVISIM
Subdivlslon Improvernent Permit Clan Ill'
DATE: '' Minor Impronttsmt POrmi[ Clean iV
l.'OCATION OF CONSTRU=ON �---�••
IStre+t ar Doovrpoait at LJirmnotsl
PURPOSE OF CONST'RUMON Sketch fa=h conmue tlah platy if aptaepe/ird .
D )PTIO G =EemPA
DIMENSION OF INSTAL-1-AviON OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTIdN COST t
Itnciuding mmoval of all obi moown, nietat iala, and dttbr s, baWillitq, cam/
paeoon and placing Permaneraa
nt vrfswv and/dr teolepng Improven►.rtnl ,j
In Consideration at the granting of this permit, the applicant hetetiv agrees to,
lodenwnM; tleteaa &a leve the Cliv, m eut%onaed sofa, bNic". hwrernw rm ane vmiov*", Mattress trop+ eft seer, skew wo ail
oof ltm. 114046" or toss f wbty Prem penal or Court aman Ofd saints Out 41 efV osem nt. seek w awlwp w Pww M tiew"ni ;
heg""W4 at dww" a e preixomts routt at " W&* alpdersYktf w4kw rto 9N11 1r Irenied punu"I to Qui aaplmaw.
NatttV Oro Adentntovena Akitom a heirs trwn"4wr 1241 Routs in edvel 41 the tern When Niaw t WNN be 0—tod,
t:emswr entn en eowtostw Ira oravwrcir. the tri 0 tn. t»n"P.i.rt ":tea ui+Wio'MftjWM.11;`ehv airs a "t?i:' Fl;
ti:,=•.a, ..v ,{J Quinn I.
tD aiev Err rity �clariri+ lriNJJrAfYMOt neprniryy0"�he'IMtiQ o} firr m' f -"•r° ! ;': ;''v•
op
�y�j a
al of AppiicMR r Agent
ame or Aoptrrint l ea art 1 Business Address T41soa mne N ,
ivaine or Centramw Ono 1! F%epma+t - - Business Addmt Telephw)d
Contractor's L.censa No CIN Butmau Licersw No,
42
Apoiicartt's Inturanek t wrivehy Polity Numoer
HHS; Subdivision irrtprt rikinvin Permit -Claes Ill
Public imoroveeriemi J% of ofumatad consruetton Cosa
Private rnitrow"wia: 3% of ammetad eonstrucnon costa N0
Minor lmorovement Permit - Class IVs Sae etuehed ikahMuiO e
Insceetion Fee
Pvrmtt Fee
S
Penuty - - — — - — —
Cuh Demit-Surety Bond
If evouvoct
TOTAL:
Re010t No.
Aftervee by Dag —
Reeoroed by
PERMIT VALIDATION
. jrr'•
:15WIT ::O.
DATE APPROVED - - — .•
EXPIRATION DATE - - - - i•
DATE ISSUED
By ., M
Adrniricaustrva Authority