1205v
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
DATE
September 6, 1991
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment
DESQRIPTION OF CONSTRUCTION Bomag Grinder
10 gide, green weight. All else legal.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Haul Route: 52 @ City Limits to
Washington to Bermudas and to
Durango
Haul Date: One Day Only w
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:
Friday, 9/6/91 OR Monday, 9/9/91
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless fromandagainst 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.
__T'WA 64KACV`(
Signature of Applicant or Agent Tina Gracey
TARMAC CALIFORNIA, INC. ON FILE
Name of Applicant (please print) Business Address Telephone No.
ON FILE
Name of Contractor and Job Foreman Business Address Telephone No.
ON FIDE
Contractor's License No.
ON FILE
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10.00
$ 10.00
Received by Date
PERMIT VALIDATION
PERMIT NO. 1205
DATE APPROVED 9/6/91
EXPIRATION DATE 9/9/91
DATE ISSUED 9/6.91
By
tl Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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NOTE:
With proper validation
this form constitutes an ' CITY OF LA QUINTA
encroachment permit
-APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OF Tft69`�
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
DATF. September 6, 1991
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment
DESgRIPTION OF CONSTRUCTION Bomag Grinder
10 wide, green weight. All else legal
DIMENSION OF INSTALLATION OR REMOVAL
Subdivision Improvement Permit —Class f I I
Minor Improvement Permit Class IV.
Sketch (attach construction plans if appropriate)
Haul Route: 52 @ City Limits to
Washington to Bermudas and to
Durango
Haul Date: One Day Only —
SIZE OF EXCAVATION, IF NEEDED Friday, 9/6/91 OR Monday, 9/9/91
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 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 i61A
Signature of Applicant or Agent Tina Gracey
UYUKKKEMPM TARMAC CALIFORNIA, INC. ON FILE
Name of Applicant (please print) Business Address t• Telephone No.
ON FILE
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE
ON FILE
Contractor's License No.
City Business License No.
ON FILE
ON FILE
Applicant's Insurance Company
Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
r 1205
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
PERMIT VALIDATION
Permit Fee 10.00
PERMIT NO. 1205
Penalty
9/6/91
Cash Deposit -Surety Bond
DATE APPROVED
if required _
EXPIRATION DATE 9/9/91
TOTAL: $ 10.00
DATE ISSUED 9 6 91
Receipt No.
ByT--_,
- Received by Date
Administrative Authority
Recorded by
TELEPHONE: (619) 564-2246
SEF'— 6-9 1 t= R .I 9 o u7 MAS P 0
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NOTE;
Why+ Draw velids,
this form conmjWtu on
enssro,d+ment aermK CITY OF LA OUINTA
APPLICATION FOR PERMIT
PUSLIC WORKS CONMUCTION (ENCROACHMENT)
For the e*n,trueubn of Rutyllc V prr4PW curbs. drrypvvays, Wverne1e0, tidwniks, parking jou. tetver�,
AnCl other like puplic s i menvi In connacnan w,th MINOR IMPROVEMENTS shd APPROVED SU$3TiIt
MOW,
SIONS
DATE:A;Q)FF
SubdiviCon ImPrOvemont PerTtrKVLOCATtltrTtON Mlegr lmprtrypnfe,rt PvrthK C d1! ,
tSshv+ rc+anw 0 Omv�t po at r 0�smn1
PURPOSE OF CON I=ON � G
S+c�Kd, (ittSCh tw,sd'UQiBR 1,WtrA
0 RIPTEpNOFCp RUC'TIOfiI r- J�r�
r� . �G S
DIMENSION OF INSTAL ION OR REMOVAL .� � CL' S �� K ! �'%<�. /C
SIZE OF EXCAVATION, IF NEEDED Yom' %�/ t t•""a 5 /C?
APPRrxlm TE -IME MIEN WORK MLL BEGIN � _ � � �� �j �
APPROXIMATE TIME: OFCOMPLEMON�„a� r J
ESTIMATED CONSiRUCT1CN COSTS / 4 h��
{Indudinq nrnovet of All 0b9vu=on, frMtOnaly, and dObm,, backfitlinq, goon• /Y
PMOM and placing P*Munort raturts
W+q bnd/or rttAiaanq intfsrov.rr+aftr,!
In anudrlrat,on at the W-&11% of thD petm,t, the Sppli=nt hereby Agr" to:
Iritlemmty, tr•eped and a" ft Cry. go sua,Prued sputa. or i*"' "PrwenPerroe,r +>n �S !'•
peM,tree, 1MDJNNt N b4 Mint MSP, `��
rrM+Oenerq av -q Mwn DAMN w tovrz Aaron and ahIImy M at 4" eOG,aerrt,♦ from • am �
q r e omxwst�, mwff til any wq.k woeruften uhaw the a,m,rt rwep �.wo me � Olrn,ny t�eY
Nimpy t» 4"-n t}►, 6vMugtT ND me apptgW"
�e+rt+„w Avtt,oe.ty as stuff 1wo^tv+�v/ t3{1 Abvey m of ti,a tRha u+,on �tl tM11 00 tt,rHp,
is mory VPM ,U Atowcob a GN Qreow+ . tr, ti, a+d WN4.10oer,o at Me tfsrrrr
li Qu,n1a Ong to tvw fw a" atd"iwo 'P~""rt R VI n•v s�v at Ane .e,,,,t p} Fr IMAMeta fora, Ont ptb,
rror. et of ary
r•art, o1 5.:w
tiro of Applmant or Aypnt .
NOW of Apour nt tale,rr crintl .
8us,nosy Addres,
. Tplapnenp Np, ,
Name or Contractor ane b For mn
Buvritu Address Tole
n.
Contractor t L,eense No,
City Suunase Lianse No.
Mpuunt•z fryutante Comuny
Pali_ry Nunrbar
FEES: Subo,vit,on tmpayw,yr+t PermK .
Class IN
Public Improvemrrttst 3% of ",2,W10 enrutyva�nn eoses
Private ,mcwv-' ?M: 3% Of *m"WII/d con m. =on carq
Minor Imo►ovemw,t P",t – C1Al2 IV: Sae attaoneo schroule ®
,ntotcuan Fee 3
Fefmrt Fee
?ena,ry
Cash Oeoey,t•Surnv Bond
If rpovired
TOTAL;
RM101 No,
Rap,yoo by
Data
tt@aw*W by
PERMIT VALIDATION
DATE APPROVED
EXPIRATION DATE
PATE J=EO
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Aenta+Qvt+t�u Auprorrty
TEL L: (alp) sY64.Z48