1209NOTE:
With proper validation
this form constitutes an
encroachment permit
i
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
DATE
September 12, 1991
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 966 Loader. Green weight
10' wide, all else legal
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
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:
Route: 52 at city limits to
Bermudas to Sonora
Date: 9/12/91
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 .
TARMAC CALIFORNIA
Name of Applicant (please print)
P.O. Box
Signature of Applicant or Agent
Business Address
Telephone No.
Standan Hauling
Name of Contractor and Job Foreman Business Address Telephone No.
On File
Contractor's License No.
On File
On File
City Business License No.
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
Received by
Recorded by
$10.00
$ $ 0.00 � .
Date
1'.-0,
PERMIT VALIDATION
PERMIT NO. 1209
DATE APPROVED 9/12/91
EXPIRATION DATE
9/12/91
DATE SU A 9/12/91
By
Administrative Authority
TELEPHONE: (619) 564-2246
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f
NOTE:
Whth wooer yalidrb0e1.
Z.- this form mnsututrs an
encrosv'mentoe*mm CITY OF LA OUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For tna mnsuytu
and ouhar like DuWic Of public or private curos. driveways11
. 1311"'1"10. sidamiks. parking Iota. sawan.
"corks ON
emir-.
improaartwrd in connection with MINOR IMPROVEMENTS and APPROVED
we-
' SUBDIVISIONS
DATE: Subdivision Improvement Permit — Class 111
Minor Improvanren Pert par IV
LOCATION F CONSTR ON
ISeraet aodren or 0 -
PURPOSE OF CONSTRUCTIONSC
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION 0 EMOVAL
SIZE OF EXCAVATION. IF NEEDED
Sketch lattach construction plans if spproopriey�I
Z
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(Including removal of all obst"C'On, ressenals, and debra, bactfilli
Pachon and placing Permanent resurfacing and/or replacing mit► /
improvarrlants)
In consideration of the granting of this Permit. the appiiant he agrees to:
I1`161mnity, deteno are were the Ci", m eummusa sp.no. officm. "On""w onvd and ww"'ve", hsmftu hen aro
Oww"W1. e�eed�tiw or ion "wit" from Vane or court aawn and arm" an Of any iloe OOM. 100 a.
ap.ns[ any awd w
n+oa^e4 a oco—n r s aoanua "crit of any wort und�roean Yrow the per,ers peered pyr r m � to o"�'* a onarty
NaiN ms Aom�n■snreti Au avaoeo".
treorm, r seat ewe" -four 1241 hours in adyarme of he time when wore wul b arsysd.
Comer w+a iii amnia Ci" Oro■cry. tM wrtree and lenmtear of the ow"M aro w amowe nisi erfo repraho,e of tM d
V Quinn eno to seev fo. er" eoertiorn npyq�m "s�Y as rhe re+wt a>mn wen. d
Name of Contractor ano bo
Contractor's' L•u
Signature of Applicant or
Business Address
Taft
Phone, No.
Business Address
Teleonorse 1i3.
Ciry Busineu License No.
Aoot,cant•s In1u1'1111e111
r
Policy Numter
FEES: Subdivision Imorvva,,w Perron —
Clan III
Public improve,ne11: 3% Of elurnated mnstrvRtOn ensu
Privateimproyernr11: 3%of astirrntod construction Costs
Minor Improvement permit _ Clan IV: SM +ruched schedule lr �T
0
inspection Fee S
Permit Fee PERMIT VALIDATION
P11nairy 'ERMIT %0.
Cash Depcsit•Surery Bored
if r+duvCrd DATE APPROVED —
TOTAL:EXPIRATION DATE
L_
Reoe,ot No. DATE ISSUED
Reaenred by By
Data
RaoorOed by Admmlrtrau" Authorny
TTLF_P14ONE- 118191 564ZZ48
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