1122IIs :r..;z yc�,. ./" •t�, .. ,_ •
NOTE:
With proper validation
this form constitutes an ,,•'
CITY .OF LA QUINTA ..
encroachment permit
APPLICATION -FOR ,PERMIT;
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the .co.nstruction 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 I I I
DATE: Minor Improvement Permit Class' IV ` ' ``
LOCATION OF CONSTRUCTION
.(Street address or. Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if a.00ropriate)
DESCRIPTION OF CONSTRUCTION 623 SCRAPER
15'6" H 111101" W 120,000 LB ROUTE: WASHINGTON AT 111
SOUTH $0 52 TO BERMUDAS TO
MONTEREY AND.TO ALVARADO `
'DIMENSION OF INSTALLATION OR REMOVAL
DATE: 6/12/91
SIZ E"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)
Inconsideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers representatives se tatives 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. 4
No 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
TINA GRACEY
TARMAC•CALIF/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.
ON:FILE ON FILE
`Contractor's License No: City: Business License No.
ON FILE.
Applicant's Insurance Company -Policy Number
t
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
, y V
Private improvements: 3% of estimated construction costs
.:..Minor Improvement Permit — Class IV: See:attached schedule
Inspection Fee $ PERMIT VALIDATION
10.00'
Pe"rmit Fee PERMIT NO.
Penalty ... 6/12/91.
Cash Deposit -Surety Bond DATE APPROVED '
if reo4 uired' 6/12/91
EXPIR
ATATE
`TOTAL: $ 10.00 D E ISUED 6/12/91
Receipt No:
Received by Date
t
Recorded by
ay
dministrative Authority
TELEPHONE: (619) 564-2246
• ;ate
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,
NOTE:'
With proper validation
.this form constitutes an
encroachment permit CITY OF *LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
7
a
For the construction of public orprivate 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 I II
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) .
DESCRIPTION.OF CONSTRUCTION 623 SCRAPER ROUTE: WASHINGTON AT 111
..15'6" H 11110111 W 120,000 LB
SOUTH SO 52 TO BERMUDAS TO
MONTEREY AND TO ALVARADO
DIMENSION OF INSTALLATION OR REMOVAL
DATE: 6/12/91
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 agains y, 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.
No'tify 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.pIl 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 TINA GRACEY
TARMAC CALIF/MASSEY. P.O.-BOXQ4050 PALM DESERT
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
Applicant's Insurance Company Policy Number
FEES.: Subdivision I mprovef.nent Permit —ClassIll
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
-07
inspection Fee
0
1122
PERMIT VALIDATION
6 10.00
mit Fee ' 'PERMIT NO IIZ—Z—
Penalty
Cash Deposit -Surety Bond
ifrequired
TOTAL: $
10.00
Receipt No.
Received by -Date
Recorded by
e
A
DATE APPROVED 6/12/91
EXPIRAT
6/12/.91
RV
N-"--Administrative Authority
4
TELEPHONE: (619) 564-2246
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Extended Page
CITY OF LA OUINTA
APPLICATION FOn PERMIT
PUBLIC WORKS CONSTRUCTION 1ENCROACNMENT6
For the conitrucsian of pursue or Prrowl cum, &,vows", pevutwe, . stdaveatks, punting tots, wooer, t+.0 srashse•.
and other like plthlic wtarke W4ww errwfret In eonnoman with MINOR IMPROVEMENTS anti APPROVED SUBDIVISIONS
Subdivision imorovenwrt P& Mrt d Class UI
DATE: .•-- ! Minor Improvow t Pelma daw IV
LOCATION OF CONSTRUCTION
' — .�-•.... .:.ter �,,.,�,,.__. ,.r...�e,�
ISa'#et #ndr.as a Paar�a►oea of Lecaaortl
PURPOSE OF CONMUCTION , Ske rh fatuch conmuctio talons if ppt,eprisd}
0 I4, N O CDrtvAu rIo494 t�sgd 44-5
off .
S ode
DIMENSION OF INSTALLATION 08 REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN (WORK WILL BEGIN
APPROXIMATE TIME OF COMPLEnON
ESTIMATED CONSTRUCTION COST S %
Ilnduding tvmonl of all ob5twtwn, se5s•orr+aiv, and debris. baekfillirgl, c0M-
m an to ' l to
De on d P rang pertrartant ttttta•isan$ andlor rep I< M itnprove+tterrtal
In conslderstion or the granting of this permit, the applicant harew arm to:
IneahrroN, detmd end save ins G+v. Rs eutnonaad ogms, otiken, rwrPam 12"M ono eTowvaa. "Men from and Sonia mer mse 64
ve4twt, fiebdq{es w tern rewrap flim utwft 6r tzuA anew% end areal g,n 6104 eetalant, too w 6vftw to faeratdw of ""IV ,
%woanay er owLot" as a 3r+*zwmta mwn of env word umwottm Vnosr V4 omwnt traeted taumum t0 .vs aeetimum.
N*10V the Adeunqu"* Aw"w w at Yssa bwervor4our 1241 ll 6t to #dine of cite time 01hen piortt lM!!, >at 60~..
Y apana6Ce tv Ora. Moa.lrio ar.o .•, ','
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rrr-
8. '7
71
iv O .2,, ' %snaturs of ARpltcant gr fpra . _ . ' ' _ _ /
Narne or Acaucant tplesse orintl
Nam# or Cantraaorolia 4otr Foremen
Addrtn
Business Address
Teieahone No.
City Business License No.
//e
Aooltcant•s Insurance Comoenv Palicy Numner
-
FEES: Subdivtsion tin Pttmet —C4u Irl 1
Public imdrove&ma: 3% of eevnLated eamarumian Lassa
Private tmcroverno ".1 3% of s=matol constmcvop costs 1� O / J
Minot Ilnoroverntnt P"It — Crass IV: Sae atmated schedule /
0104etlon—
oarnut Fat
Pahalty
Cash D#nostt•Surety Bond
If reoutreo --
TOTAL: S
RWtPt No. — - — —
Olom ea by Data _. �..._..+ .�
Recorded by
PERMIT VALIDATION
-
DATE APPROVED
EXPIRATION DATE
DATE ISSUED V
AdmffidU lute AUOWnW
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