1119NOTE:,
. f
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT r :I-
' ti
• � PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)""
^ 4 R r pF
For the -construction of public or private curbs,- driveways, pavements, sidewalks, parking lots, sewers, waterrmains
and other'like public works improvements in connection with MINOR IMPROVEMENTS and°APPROVED'SUBDIVISIONS' ,
Subdivision. Improvement Permit — Class l l l
JUNE 'S, 1991
DATE: j Minor ImprovementlPermit Class IV -
LOCATION OF CONSTRUCTION]
(Street address or Description of. Location)' "
` PURPOSE OF CONSTRUCTION MOVE EOuin En Sketch (attach construction plans if appropriate)'
DESCRIPTION OF CONSTRUCTION CAT D8K DOZPR
R.AUL ROUTE: 111.. AND WASHINGTON •
STREET, SOUx11'-TO AVE `50, .LAST TO,
'DIMENSION OF INSTALLATION OR REMOVAL 1446"' Irk. 1416" 'W PARK -'ST'
'..� LBS 126:55
f ' HAUL DATE fi//�1
6 `
^ ~ SIZE'OF EXCAVATION, IF NEEDED-
APPROXIMATE
EEDED APPROXIMATE TIME WHEN WORK WILL BEGIN
QNB •PXLOT CAR' REQUIRED. .
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 5 • - ' j
y' (Including removal of all obstruction, materials, and debris, l5ackfilling, com-
paction
om paction and placing permanent resurfacing and/or replacing, improvements)
In. consideration, of the granting of this permit, the applicakt 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 puu3afi tb'fffs avl,iA&tit
,"6 05a 91 '0
Notify,the Administrative'Authority'at,'least 'twenty-four (24) hoursinadvance of the time when work wi 11 Inte'
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.
i - r Signature of Applicant or Agent
Name of Applicant (please print) , Business Address ry ;c Telephone. No. .
DALTON TRVCKING'' 13560 WHITTRAM FdNTANA .714•$23-0663 +'
Name of Contractor and Job Foreman Business Address , Telephone No. '
Contractor's License No. City Business:License No.
k .UN i n - Ott
_ FtLE
' Applicant's Insurance Company •Policy Number a ;
'FEES: Subdivision'lmprovement Permit — Class III
Public improvements: 3%.6f estimated construction costs, •, k. ��, -
. Private improvements: 3% of estimated construction costs E
r , 1y
Minor, Improvement Permit — Class IV: See attached schedule
Inspection'Fee $ PERMIT VALIDATION
Permit -Fee • 10.00 PERMIT NO. 1119 w '
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
10.00
Receipt No.
Received by Date
Recorded by
DATE APPROVED .
EXPIRATION DATE
6/5/91
6/6/91
6/5/91
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246
y,. .e .ti. ,,�$ir%;a� .�f 'I�i '��i" i"r•:- � �' ,.�3i �Y'�. Y � S;A�; +'-:: -"1:r� ..ilF c ;�•",�l
w
NOTE:
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
DATE: JUNE 5, 1991
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE EQUIPMENT
DESCRIPTION OF CONSTRUCTION CAT D8K DOZER
DIMENSION OF INSTALLATION OR REMOVAL 146" H. 106" W
LBS 126.55
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)
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:
1
HAUL ROUTE: 111 AND WASHINGTON
STREET, SOUTH TO AVE 50, EAST TO
PARK ST.
HAUL DATE 6/6/91
ONE PILOT CAR REQUIRED.
d
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 p'"5'ah fb, Fji"I
� Tc'8t1t6:-O5-9i 13
it GAS 1� `OTA! i 10.QO
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work wi 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
Name of Applicant (please print) Business Address Telephone No.
DALTON TRUCKING 13560 WHITTRAM FONTANA 714-823-0663
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
ON FILE ON FILE
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
;. 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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 10.00
Date
1119
PERMIT VALIDATION
PERMIT NO. 1119
DATE APPROVED 6/5/91
6/6/91
EXPIRATION DATE
6/5/91
DATE ISSUED
By �
Administrative Authority
TELEPHONE: (619) 564-2246
encroachment permit U 'I Y U I' LA UU I N 1 A
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
• DATE: / - 1?/ Minor Improvement Permit Class IV'
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction -plans if appropriate)
-ro
DESCRIPTION OF CONSTRUCTION P.A-r n n,�) 9 Fv_ IT • y��i . 2pB � �// AtiD
3—ne'ee 7 - .So. )ro
D1 INSION OF INSTALLATION .OR REMOVAL �h"� " ��"� "•L-' .� E9A�
SIZE OF EXCAVATION, IFNEEDED
ft/NoX .DR7E: 6-6=9/
APPROXIMATE TIME WHEN WORK WILL BEGIN,
APRROXIMATE TIME OF COMPLETION pnJE PLL OT (-,AM� Qut12IP
ESTIMATED CONSTRUCTION'COST $
(Including removal of all obstruction, materials, and debris,'backfill ing, 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 authorised 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 anywork 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. J
Comply with all applicable City Ordinances, the terms and,conditions of the permit and all applicable rules and.re_gulations 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
`Name of"Applicant (please print) Business Address. Telephone No.
Aa .vim it r"s� 9 M A nj A-�Z."4
Name of Contractor and Job Foreman Business Address z Telephone No.
AV
Contractor's License No. City.Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit— Class 111
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 VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
'TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT NO.
DATE APPROVED.
EXPIRATION DATE
DATE ISSUED y�
By
f' Administrative. Authority
TELEPHONE-. (619) 5642246