1152"phi 'ytn ' r
,NOTE 1
With proper,validation -
this form constitutes an '-CITY , OF' LA QUINTA
encroachment permits - ' - • ..
` APPLICATION' FOR PERMIT
' �• �" �tib'=:
PUBLIC WORKS' CONSTRUCTION (ENCROACHMENT)c
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
'^� 1•' Subdivision Improvement Permit — Class III
f1
7/16/91 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
'•t'T, ,'•(Street address or Description of Location)
.' 623E SCRABBER'#6970
PYROSE OF C�OI��TRUCTION Sketch (attach construction plans if appropriate) -- t
15 6'H' .11,10 W •120,000 LB HAUL ROUTE:
DESCRIPTION OF CONSTRUCTION
ALVARADO - NOGALAS- BERMUDAS
= _ 52.OUT OF CITY -LIMITS '
DIMENSION OF, INSTALLATION OR 'REMOVAL
F .
SIZE OF EXCAVATION, IF NEEDED
.: '�t'.. •. - - .
APPROXIMATE TIME WHEN WORK WILL BEGIN 7/17/91
-.APPROXIMATE TIME OF^COMPLETION 7/17/91 ,
,
ESTIMATED CONSTRUCTION COST $
(Including•remo'val of all obstruction, materials,'and debris, backfilling, com
paction'and.plaping-permanent resurfacing and/or replacing improvements)
In'consideration of,.the grantingsof this permit, the applicant hereby agrees to: '
` �Y Indemnify; defend and save�the"City, its authorized'agents, officers, �epreseritatives and employees, harmless from and against any and all
^perialtier, 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 Ordinarices, the terms and conditions of the permit and all applicable rules and regulations of the City of
°.t La Qui nta and to pay for any additional replacement, necessary as the result ofrthis work.
Signature of Applicant or Agent '
B.� PHILLIPS
' TARMAC- r CALIF. 1' P.O.'. BOX 14050' r PALM DESERT; ' t
Name.of Applicant (please print) ' , Business Address' s Telephone No..,
Name of Contractor and Job Foreman �, Business Address Telephone No.;
ON FILE' , -ON FILE
Contractor's License'No. City Business License No.
R i
ON ., FILE i
'Applicant's Insurance Company Policy Number
. F
FEES:, Subdivision Improvement Permit-- Class III t
Public improvements: 3% of estimated construction costs 1.152 Private improvements: 3% of estimated construction costs 1 1 5 2
Minor Improvement Permit — Class,IV: See attached schedule
.' Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if,.recluired
TOTAL: $ 10.00
Receipt.No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 7/16/91
EXPIRATION DATE 7/17/91
D�717SS ED 7/16/91
By 11
Administrative Authority'
TELEPHONE: (619) 564-2246
•k r
»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
7 . 7/16/91
VL'OCATION OF CONSTRUCTION
Subdivision Improvement Permit —Class II I
Minor Improvement Permit Class IV
IStreet address or Description of Location)-rr,0APt a—
PURPOSE OF PON 623E @CRABBER #6970
ISTRUCTION Sketch (attach construction plans if appropriate)
15'6'R 11 10 W 120,000 LB HAUL ROUTE:
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
' APPROXIMATE TIME WHEN WORK WILL BEGIN 7/17/91
APPROXIMATE TIME OF COMPLETION 7/17/91
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:
ALVARADO — NOGALAS— BERMUDAS -
52 OUT OF CITY LIMITS
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.
Signature of Applicant or Agent
TARMAC CALIF. P.O. BOX 14050 PALM DESERT B. PHILLIPS
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 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: $ 10.00
Receipt No.
Received by Date
Recorded by
1152
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
7/16/91
7/17/91
EXPIRATION DATE
k,t.., .:.o—
7/16/91
DATE'1'SSU E D
By , ,
•.L.,II
Administrative Authority
TELEPHONE: (619) 564-2246
P.
T U.E 05
NOTE.
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this tom conmana an
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CON' UCTION (ENCROACHMENT)
Fat the cariMCLIGA of wi.,
Pu at PIMA w A. at ys. 6-voirom. valwalket pmlriq IOU, savmv, wnwwokw,
And other like Putwic woq*o injoto grt*" In woomon with MIN04 IMPROVEMENTS end APPROVED SUJIDIV1&16ja
sawiviiian Imam"riven Permo Cuss Ili
DATE..
Minor IMWO"Tviorrt F*mrt Cift IV
LOCATION PF CONMUCTION
PURPOSE OF CONSrAUC710N
Sketch (4ftch awwouttion plans 11
DESCEPTION OF CONSTRUCTION pea -W,
-DIMENSION OF MiTA ATIONORREMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK VnLL SCISSIN r?
APPROXIMATE Tim ' E OF COMPLETION
ESTIMATED CONSTRUCTION� COST t
(I , Acluding removal of all q6rv%=jan, tept &is, and debris, b&cktijjirq, COM.
.Psctdm mftd placing Pgm"nt nft4-Nwq and/or replacing irmproverama)
In conswctsuaft of the wtirm of ft vit"n1j, the 1kopficarij heraw arm to,
inde—Ow, Wend area w" theCitv, M bufftwn26d e"ftft. atkers. Mftv*Mvw" and wr*Wws, MM"o" IMM gM epwo &W jiipi4 a
lwbshli" V mm Moushteq town Comm or Court mloa wo sm" MR of a" as Im aw Can to pwwu
116OWN4 of omwmq as a peuxavvils mw" of S" *a* vftwricin area* go v~ wan"d oun"m " tars aimomft".
Nouty Me Aomsmruw" AkueorytV a Wm m" ey-00ur 1246 Nw" I" OOVW40 &109 Wven was VAII be owMo.
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COMOV VnIh Wf 8004*W CJtV Ord w M arms IM tandimv of thd owm" Ilreji Ni ownwwe nAw dow "4Uw1wv of He an of
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4,
15
S; Full ;qh of Appl, nf
cz or.
Of Avo
Name at Apoorint IvItair orint) Busirms Address Talsonom No.
`Name or Contractor sno Jaz Foreman Ousineav Addrott No.
iQ 12 -
Contractor-$ L-canza No. City Business License No.
AvotwAntls insursm Comaiiiny Polivy Nummr
FEES: Subolvisicn OnarommoYl Permn –Clap III
Public iniorave, a of emmted confiructloo cum
Frovets ImPromm- nu: 3% of tsurraw coristrucman cam
Minot (mti10vtTW% P""It - VAD IV: Sao froMird lChaagle
'Alptcl 10A Fee PERMIT VALIDATION
Pvrm'I
i Fee 3C.SIMIT NO,
CA&h btoomil-Surory Sono •. DATE APPROVED
EXPIRATION DATE
TOTAL.
DATE ISSUED
Rtrouot No.
AvC mqa by
A-0ww by
07.0"