1123..�
NOTE:
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 III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
„ r
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION BOMAG GRINDER
10' W GREEN WEIGHT, ALL ELSE'LtGAL
DESCRIPTION OF CONSTRUCTION {,
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION -,LF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HAUL ROUTE: 52 AND JEFFERSON
TO BERMUDAS SOUTH TO MONTEREY,
WEST TO ALVARADO.
DATE: 6/13/91
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 propeety
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. _ 'r
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
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs { y
Private improvements: 3% of estimated construction costs i t L
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 10.00
Penalty
Cash. Deposit -Surety Bond
itrequired
TOTAL: $ 10.00
Receipt No.
Received by
Date
PERMIT VALIDATION
PERMIT NO. Z/2-3
DATE APPROVED 6/12/91
EXP( 6/13/91
TI/ 6/12/91
By
Recorded by II TELEPHONE: (619)
Administrative Authority
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NOTE:
With proper validation
this form constitutes an
encroachment permit
MR,
..ri MME^.e..P �J77
l
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
Subdivision Improvement Permit — Class I I I
DATE: 6/12./91 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
r�
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION BOMAG GRINDER
10' W GREEN WEIGHT, ALL ELSE LEGAL
DESCRIPTION OF CONSTRUCTION ti
,f
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION,.IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HAUL ROUTE: 52 AND JEFFERSON
TO BERMUDAS SOUTH TO MONTEREY,
WEST TO ALVARADO.
DATE: 6/13/91
I
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: �g
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage toy"eersons 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.,,
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
ON FILE
Contractor's License No:
ON FILE
Telephone No.
ON FILE
City Business License No.
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00 -
Receipt No.
Received by
Recorded by
Date
1123
PERMIT VALIDATION
PERMIT NO. -- 1/2"-3
DATE APPROVED 6/12/91
EXPI�T�ONb T 6/13/91
/ 6/12/91
By
.TELEPHONE: (619)
Administrative Authority
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NOTE: • ' • _ -
YVldt oro,
per Yalwatum.
, Vthft farm conttbmen,
awmnt CITY OF LA�.,DUINTA .r.
' APPLICATION< FOR ,PERMIT
.. � ; 'FuguC WORKS CO N,aMUCTION; (ENCROACHMENT)
• 1 For ma Co'sVUCytut of tY tNlc dr mate curbi. driwrwtevi, paven—,ts, sidewilkt% parici tau, wvwrr
Pu P nq wasar' srtltfins'.
r .Tana other like pubu, works,imp"mrnerrpt in eonnedmon wit, MINOR IMPROVEMENTS and APPROVEO SUBDIVISION11
` Subdivision improvarnern Parmrt — Cum 111
MI1W Improvernartt Permit Ctm IV B
` LOCATION OF CONSTRUCTION ' —�••► +�.>,;
• ISoaatt tw4r� a BerAtrrpergts aA L+bestsortt� .. .' '; ; � ,
PUiIPOSi OF COPM
IU&nON l^ Sketch (ateetit ettitravct3on plea if a ',� y,
DESCRIPTION cid CONSfIt
Ila. a 2^
0. OF INSTALLATION OR REMOVAL �L C�� `•'
^y• SIZE OF EXCAVATION, IF NEEDED���
APPROXIMATE TIME
- �!'UfitttliffLC'BEGIN ,
APPROXIMATE TIME OF.COMPLETION
ESTIMATED CONSTRUCTION COST .$ d
(Including nrmovel of all ohnrurctioh, rnatrr all. end debris, ba,�CHIIIng, aatrt-
r, r pacaan and plaanQ Porrnariant ro:ttr4surtQ end/4r raplapnq imp►ev+rnansa> C• �f/ / —"��}! � ,
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Comuty writ all sewesaia
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A0, BitMtUre of ILS IRt 4r gout ,;,
tami or amR
ACent 1plrasd ortntl Butt t{ Address
t Talopnara No. +"
• Mame 07_Contrmor
a,i i iva,+au Address
No. Yt.
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Contractor's L,ctnt. o,
City B •• •....•"•C��•• t;� ;{,
usiness LiCMso No.
".101 NOW• Polsr Nvrnaer
* FEES:" Subdivision irt+��tyvor+g+it Permrt Ctssl til
a Public imorwAmwirts: 3% of asarnased constMalon cares
Prima. 'mcirovim tm 3%t of emIrmtea contzrurnon coma
` 1 Minor Itnoroverrwant F"mrt — Ctata IV: Sell attached tt:houle l� l/ c)�3
1 tPltoac7ron Fee PERMIT VALIDATION
a .. Permrt Fee
t'ERMIT.%O.
'Pahalty�
Caen Dedosrt•surery Bond OATS APPROVED
. If n►dunad -- - 'EXPIRATION DATE
TOTAL:
-,- _. DATE ISSUED,
' Aeca10t No.
F"aernati by - `' Fated