1155NOTE':
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
` Subdivision Improvement Permit — Class III
DATE: 7/19/91 Minor Improvement Permit Class IV
LOCATION, OF. CONSTRUCTION
pi
s .1•
1
(Street address or Description of Location) h^""
PURPOSE OF CONSTRUCTION MOVE EQUIPMENT Sketch (attach construction plans if appropriate)
DESC IPTjPN OF CONSTRUCTION BG 265 PAVER ;'` HAUL ROUTE: J
1 6,W, GREEN WEIGHT ALL ELSE LEGAL ,.
ALVERADO TO NOGALAS TO BERMUDAS
p' DIMENSION OF INSTALLATION OR REMOVAL 52 TO WASHINGTONTOUT -OF TITY
LIMITS. RETURN BY SAME ROUTE
ON SAME DAY.
SIZE OF EXCAVATION, IF NEEDED
APP O IMATE TIME WHEN WORK WILL BEGIN 7/20/91 OR
72 91
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ HAUL PERMIT VALID FOR ONE DAY
(Including removal of all obstruction, materials, and debris, backfilling, com- ONLY.
paction and placing permanent resurfacing and/or replacing improvements)
I. r 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.'
I� `
Signature of Applicant or' Agent B.pHILLIPS
r
TARMAC P.O. BOX 14050 PALM DESERT 4d
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 i ON FILE
Applicant's Insurance Company Policy Number K
I( FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs I, 55
Private improvements: 3% of estimated construction costs
Minor Improvement Permit— Class IV: See attached schedule
1
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
w
< ifrequired
t TOTAL:
' Receipt No.
20.00
$ 20.00
Received by Date
Recorded by
r
°PERMIT VALIDATION
PERMIT NO. 115"T
DATE APPROVED 7/19/91
EXPIRATION DATE 7/28/91
DATE ISS U,E7/19/91
By tZ�=�,c.�
Administrative Authority
TELEPHONE: (619) 564-2246
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JUL-- 119-19 1 FP. I 1 4: 56, MAS P 0
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NOTE.
wish ow Dw vatielfbgf,•
this form aoftimpim an
eneoachntem CermR CITY OF LA AUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
I For the conmuctw of'va
and either 1(ke Pubic M prlvota trub:: drihrwya, pavfinense, sidevreika, park(nq loft, Sewell, srflaardt�e.,
public vrarka Imptraaerneim in connection with MINOR IMPROVEMENTS and APPROVED SU6DIVI8I&4
DATE: "' 1 Sadidkion Improvement Perm" —CLM
Minor Imps ns Pmllnrt dim iv "
LOCATION QF CONSTRUCTION
i5trfft ama+a+t10� Oa.pr,pdjq of Lamnoahl ,
PURPOSE OF CONSTAL}CTION $kM +t�di (ecud► oanrbvstion plans if q
aprlRoi)
OFSC51PTIPP OF C NSTRUCTION
DIMENSION 0 STALLATION OR REMOVAL r �• OtJ
51ZE OF EXCAVATION, IF NEEDED
APPNOXIMATE TIME YMEN WORK VWILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONMUCTION COSTS
(including fempvel of ail Oba„nuttaesn, 1410h all, and deliria: backtilling, bons•
pacbon Ind piecing palmemrst r"Urf3mg and/or replacing improv wm,tsI
In Consideration of the granting of this permit, the applicant herebv agrees to:
Indantn,ty, oefv4 am NO the Cihr, It fvinonied 4,pno, offlbft, rfp.'famntethaa aM W010yoa, Imm"RM from slid +aom MV 0004 _ ,
panalem, lybillliej or I t1 rowittnI tram pawns at churl. wtion ONN V111" ehrt of arty aeeaiant, Iyp pmt OfraaMei if
v 00"M a oaoxwmu fawn at env tomb &4
40-Jw ftn Ynasr thy 0a+N11 Ifarltad av+wfnl !0 d1a aP�lkt+e
NOUN en• Adminutntara Auv$w" at Mit h*ftw.lour 1241 hov" in 4drlw7f of the An@ when htiath rtiu lM
Conde vans 111 /rsacdwbW C$v 6eaa.e,.r w, the temp ind sem•
1J Qhunm Gno to aati for '0 Ca�+tlithoahr 0r 1110 aamllm arKt �P1w+b10 Ibrla ra6N:Rtlelil +: >r
'hv fomtle,w nawoan+.*s nrcv.v a rnr'rf.�tt of Uri wo anp ! db sl `.`,;' ?.?.;•: w
~ Jc'�gT1a t AppitcanL A9ft1t .
Name or Aoollcant Ipleaw print)
BusiMss Address Tflfarlor� No.
Name Cr Contractor and Jog Foreman
Bus,ness Address Telephone No,
Contractor's L.Unte No
City Bus,nals License No.
Aoprlcant's Inturanpe Comt*sy
Policy Numeor
FEES: Svbdivltion Imorv,frr>mnt psrnhrl , Cbts ill
Public improwilw1u: 3, at trarnow eonstivetlon eel
Privet# 1m0rov*`tent3: 3% Of twMAlad conftrticaan em
Minor Improvement Permrc Clait IV: See attached schedule
Inspection Fee S
ptrrnls Fee
Penahry
Crab 000ort•Surary Bong
It rvoultod
TOTAL,
Receipt No.
Al"N" by Dater
Record" by
PERMIT VALIDATION
'UMIT ,,o,
DATE APPROVED
EXPIRATION DATE
DATE ISSLIEO
By
Admmatrmm AuMce fty
TEL.EPP.M& (019) 664.=46