12111.
NOTE:
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
DATE
9/13/91
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Grinder 10'6" wide
green weight All else legal 52 at City limits to Bermudas
DIMENSION'OF INSTALLATION OR REMOVAL Haul Date: 9/16 or 9/17
One Day Only
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 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.
SNA;eAY
Signature of Applicant or Agent Tina Graeey
TARMAC CALIFORNIA P.O. Box 14050 Palm Desert, CA 775-8267
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 -Tile On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs ! c
0
Private improvements: 3/0 of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
r
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond,
if, required
TOTAL: $ 10.00
Receipt No.
Received by
Date
PERMIT VALIDATION
PERMIT NO. 1211
DATE APPROVED 9/13/91
EXPIRATION DATE 9/17/91
DATE ISSUE13
By
AIQMA8Authority
Recorded by
11 TELEPHONE: (619) 564-2246
t �.. .. � .� 1 ., J i
-------------------------=----------------------------------------
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
i APPLICATION FOR PERMIT 1$
1 PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
C� 0 TFlB��s
i
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water main's
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
i
Subdivision Improvement Permit — Class I I I
I
DATE: -9/13/91 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 Grinder 10' 6" wide
green weight All else legal 52 at City limits to Bermudas
t DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 9/16 or 9/17
One Day Only
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 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 Tina Gracey
TARMAC CALIFORNIA P.O. Box 14050 Palm Desert, CA 775-8267
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Talephone 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 1 2 1 '1
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
- PERMIT VALIDATION
PERMIT NO. 1211
DATE APPROVED 9/13/91
EXPIRATION DATE 9/17/91
DATE ISSUEO 11/91
By.
Administrative Authority
TELEPHONE: (619) 564.2246
III
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I'
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CITY OF LA OUINTA
APPLICATION FOR PERMIT
PUBUC WORKS CONSTRUCTION JENCfiaACtiMENTj
For till mnavy,caon of PupriC qr prtrata Ewbf, drlrtihrf, par.
Ind ouvar bka P"wic rnwm IideyraFyll, Parltlrp Jan,
>r kl impeor um" in eortr*cx fn'I MINOR IMPROVEMENTS.and APPROVED $Usb j0W
DATE
LOCATION OF CONST�UCTION
Subdirition Impr•plrt,rna� PtRhrt ,� Cl+otII!
Ailnpr ImpK FI Clio IV
Itfrwc aoornr o, prate fd=er.oant
PURPOSE OF CONSTAUCTIOM
D
I,�„fataldtolsrtttryetion
T % OF CONST UCTYON Ifow 'f aPproortaq
DIMENSION OF INSTALLA-nAN bR I! OV,1t
SIZE OF EXCAVATION, IF HEEDED
APPROXIMATE TIME yy}IEjI WO RK iIALL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED D "IS''R;tCT1ON COSTS l� t 2
CON
(Indudinq hmonl of 111 obvcrucr on,—r7a11, and dao be
Pacoon and plaan4 Parntanant tefwta +a• **filling, Cam.
in oont,derauon of tflR and/or milacinp imprownrae l
n0 of 1lsu Oerllllt, tAe apprltmrtt her,ftfy &70"W:
ino►ninry• ptrsne aro a" M. CIN, rn avd+orvae Mang. �Mlafrr, ,
A•rynNt. tr�l,riao ar rota rvwllyrpJ INrp "VM or Ooury aezlan ietl M a►rt N ,
�°�""'��.. Md anrare„a.t� �anntwa howl ana
"-o- rq a- een,nw m a w.,-O.s wn of *IN work w a+w ana+dorrr, roan "Dip of r w W
Mot11y aw Adman trwo , "0 maw tna a•wnK bhnrp tt�rrauanf b aar,�� &
Compy VI all 0M.04Avg ~ +haour c24} n M til t. 0 wNM r.o.t♦ w.11
6.
1a tL��nd a+w ro a+r a ry� OieyMing* .%k a,r� �w�ivv 2 MI jeft sFII of tta" an fat VI CtN
oo�leant I/plf��a printpf
Mama or contractor an
• o�r"an 8ut,neu
CantrlCtor 1 L•u No
vt,...
nt'In
�..hy :i•tin,.,:r `•i.' .z lj! Wit• .r:. :..5."•. ,,„""' "'"
...:.r,.. _ a'e'+i�tv.rtrf�a*n►rt..' ,•.�uRhvsxdc$ti,:�s
Cta 41
q11 :ar
. ... _ PII�IIC IR+pfipy�ertijrjp: f
. Frivau �mDrrl.wtrna: �'K a}�nafad'r�nrtrf,et�on eom`
r mat/ti Wnttrucrion CprQ
Minor (MorpvtMMi Pe•mlt — C4if Sat otoa+ro fd,.oulo
IMotCtlOn Fte S
ptrmrt Fee
Pan■r ty ,
Cash daooflt.Suratuay Sorb
if raoud
TOTAL;
R91=101 No,
RK++roo by
of Appliesnt w
ko,
clwouprfafa t.;eltn
"t
.. ':' ,:•yam.. .r,�d'� :i V:i� 'b.. �,:••F . � - .. �.�.1
Nn
PERMIT VALIDATION
DATE APPROVED
EXPIRATION DATE
DATE IMEO
Dr
Admin a va Wa Au»,orny
TEL•EF'ffOMIL. (dig) 68a_re..