1210r
NOTE:
With proper validation 4
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT ar
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
9/13/91 Subdivision Improvement Permit.— Class III
DATE. Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Move Grinder
10' wide green weight — all else legal Durango and Bermudas 52 to City Limits
DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 9/13/91
SIZE OF EXCAVATION, IF NEEDED
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 propefty.
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 California P.O. Box 14050 Palm Desert, CA 92255 775-8267
Name of Applicant (please print). • Business Address I Telephone No..
Name of Contractor and Job Foreman Business Address Telephone No.
On file
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 I
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 y
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00--i-
Receipt
0.00 +-Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1210
DATE APPROVED 9/13/91
EXPIRATION DATE 9/13/91
DATE ISSUED. 9/13/91
By
Administrative Authority
TELEPHONE: (619) 564-2246
SEP -13-91 FR I 1 1 : 1 7...M.AS
NOTE; '
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rndo.arrwrn otxlr,rt CITY OF LA GUINTA
APPLICATION FOR PERMIT'
PU6UC WORKS CONSTRUCTION IENCROAC 4MENT)
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For tnr contvurt+on of publit of prwta Virts. dnvowrv+, prven»rrn, /rdrrniks,PAPI IOU,
and ottrrr filer PI"I Imps in oonr*=On with MINOR IMPROVEMI NT$ g,4 Ap op r�
SUBDIVII11 N3
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LOCATION c CON ICON fAlnor lmpeprr,relyrnmrt IV„� `' •,.
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PURPOSE OF CONS; RUMpN
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DIMENSION OF INS;ALLJITI �j 5 '/ f
SIZE OF EXCAVATION. IF NE@DED
APPROXIMATE TIME MIFN W0IiK MULL BEGIN
-------------- e3
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS
Ilreuding r.rnovrl of all obgmcmm, Ole, ono dtrbro, br I (illi
"=on end plJianq Pi'ww wm nn'dr7a ng. corn•
'�4 Ilrsd/or hplednp imOrovwrrrrp) �-'•,•
In wntlderauon of the
fhaterng of tha prrttrlt, este Opprri:int hemtry &Vigil to:
oo
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l}rrrp, pfiia�• rronq.rrgrhfer � `,
nwr• I+eoil.rree r Cao hfMr-4 tmm osww w osare &I and _ 6rrA rayon. ham"r torr, sm r*sQa+M ' w••':I ;
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V tS�lnn erm In a" tar orry p0 the M+r*s or,c COrW�dors tf ehe Prtmrr Jinn SO amcmu �� - "y"7
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PrivetrImdprMrranp: 3% Of-.11vttron Coets
�7rnI COnetrucnon Coen
Minor Ir 1otovrment Permit . Clan IV: Srw orma'aa I&WOulr
Insorcilon Fee s
¢nm a Fee
?rnsrty ,
C&Ah Orowtt•Surety Borg
if "quirod
TOTAL:
ROMIRI Na,
Rootioc by
Ia.e..�,__
A� by
N0
PERMIT VALIDATioN
5`.8MIT %0,
DATE ANROVED
EXPIRATION DATE
OATt iSSLrEO
By
Admina�y,� AvOrarriy
TINL, (0101 (564,1 ..
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT bg
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
C� OF TF189�S
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:
9/13/91
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION Move Grinder
10, wide green weight — all else legal
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
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:
Sketch (attach construction plans if appropriate)
Durango and Bermudas 52 to City Limits'
Haul Date: 9/13/91
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 Qulnta and to pay for any additional replacement necessary as the result of this work.
. T► JA C Y
Signature of Applicant or Agent Tina Gracey
Tarmac California P.O. Box 14050 Palm Desert, CA 92255 775-8267
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address TeleRhone 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 I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
t
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
E
10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
1210
PERMIT VALIDATION
PERMIT NO. 1210
DATE APPROVED 9/13/91
EXPIRATION DATE 9/13%91
DATE ISSUED 9/13/91
By /A,t/'AA* __
Administrative Authority
TELEPHONE: (619) 564.2246