1110NOTE:
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
�a� M/
DATE: 11111 ? 1
LOCATION OF CONSTRUCTION _
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION —
DESCRIPTION OF CONSTRUCTION 265 Barber Greene
10' 6" wide, green weight. All else legal
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Fernando & Eisenhower
to Washington & to Hwy 111
Dates 5/22/91
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 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.
Tina Gracey
Signature of Applicant or Agent
Tarmac P.O. Fox 10050 Palm DesertCAA 92261
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.
on file on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs , 1 1 1 O
Private improvements: 3% of estimated construction costs I
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No. ,+
Received by Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
5/21/91
EXPIRATION DATE
5/22/9/1
DAT EEIISSUED
4#�Mitive
Authority
Recorded by II TELEPHONE: (619) 564-2246
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NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
Q
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
DATE
�c7/14/
S 017 1
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
IStreet address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 265 Barber Greene Fernando & Eisenhower
10' 6" wide, green weight. All else legal to Washington & to Hwy 111
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED Date: 5/22/91
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.
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 Gracey
Signature of Applicant or Agent
�N Tarmac i!'.0. Pox 10050 Palm DesertCRA 92261
Name of Applicant (please print) Business Address Telephone No.
�.. Name o Contractor and Job Foreman Business Address Telephone No.
'^on file on file
Contractor's License No. City Business License No.
on file on file
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.
10.00
$ 10.00
t
Received by Date
r '
Recorded by
1110
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED .
EXPIRATION DATE
5/21/91
5/22/91
DATE ISSUED
Administrative Authority
TELEPHONE: (619) 564-2246
P
9 1 T U E 15
—MA S
MAY -2 1
t. NOTE:
wh11 areas valirlIg6an•
this forth conn mea an CITY OF LA QU1NTA
enavaa+mem pNmrr
APPLICATION FOR PERMIT
PUBLIC WORKS CONMUCTION (ENCROACHMENT)
For the comuuc n of Public or prmte euros, drivrmYl, pavamonn, ori ft"Iks, Parking 10ta.'sewere, V, tW Mal a, .
and other UNe pudic work$ Imttowem ms in eannomon wish MINOR IMPROVEMENTS and APPROVED SUDDIVISI&a
Subdivision Imom"a ant Permit — C" Ill
� ._. Mina Imrin
promm Permit Clear (V
L'OCAT'ION pF CONSiMUCnON
lS~ trtlp.re or Da stpdit 01 Lehman►
,
PURPOSE OF CONSTRUCTION Sketch Umdl oanrruaien plant 0 appmpie f
DF=RIFTION OF COf4(RU 9N ��rrGLdtd%5�° �r��t
G
ClIMENS16N OF INSTALLATION OR ACMOV
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPt.PON
ESTIMATED CONSTRUMON COSTS tY
(Including removal of 411 obro cation, m mmoit, and, debrts. backfilling; Com.
pacoon and placing pormerunt tasurf>tw4 and/or replacing Improvemmm) �.........�,,.,„�
In 0ontlderaa0n of the granting of this Permit, the applicant hereby egren to: `
Indic -10V, asf "O aero tea the CIM, its oumoNed Brprrts, oMk*". monmonutwee ane Mfloloytae, hsnloirw hunt erre POWW hem MY ell
Poulton, lisblhtis/ or Ipa 1Mwittne Agro aawm a court anion emd Be" out of Blow owidorR, Idyl or O&WO to maim iW Grey
heoven„y of oom" a< a oiaurnals "MR of " work rnowwktn uewr eM Otreltt senna 0vtoomm to this alowenott.'
N010Y IN Adm,m.vettle AuOw"v as om moo ew-laver 1241 haws M txtvwae of aha bite srfren wan will be stmotw.
comalV "tr, all "ill" 0 Oro•rr.an. tM.thtnr Plod irji;;trtteh iif 1hr 77 K 1' r v
N ourlo +nC >b oaA+we+i N4a sna, rtgwrrloalr e•' til+'GrN t1P ^'�'r
Lit li+i�nm
t0 ow �
lir' rr+Y inirtroni ;ewcx.arnrnt'ri�e.d:rv�1D� }!�!�tlai�it t d�^
'/7 -1� J7 ;• Signature of Applicant or Agovjj,
Nana or Amimmt iolcue wind
Sutinett Addrem
Name or Contractor anti Jap F Man Business Addreo
Contrmar's L•ctnse No. i
Taletew* No.
ff�� /•� City Business Otenu No.
AoDucens's Insuranp Camany Policy Numoer
FEES: Subdivision imorowenlerrt Perm+t —Ciao lir ,r, '
Public imorowmerrts: 3% of omrnetad mnaavction earn ,
Private improwerrltn .- 3% of emmsted conrtturnon to%U
Minor lmorovement P"ma _ clatt1 IV: See otuchod sehedu(e e
M1040100. Pee
vainer Fee
r'enstty
C&sh Otborrt-Surety Bond
If Ivauuod
TOTAL;
Re"101 No,
Noweved bV - Data_..,,.....
Rtaordod by
PERMIT VALIDATION
DATE APPROVED
EXPIRATION DATF). „
OATS ISSUED
A rnmis etla Mrthorny
TELEPHONE: (61016"46