1222NOTE: _
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 18, 1991
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Grinder 101 wide
green.weight. All else legal Haul Route: Durango and Martinez to
52 and out of city limits }
DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 9/19/91 t
SIZE OF EXCAVATION, IF NEEDED
r
APPROXIMATE TIME WHEN WORK WILL BEGIN
ry
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 92255 (619) 775-8267
Name of Applicant (please. print) IBusiness Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
On File
Contractor's License No.
On File
On File
City Business License No.
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
&required
'TOTAL:
Receipt No.
10.00
$ / O O Z7
Received by Date
PERMIT VALIDATION
1222
PERMIT NO.
DATE APPROVED 9/18/91
EXPIRATION DATE 9/19/91
DATE IS UE 9/18/91
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
t
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�
... '.
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.
Ci�?Aeey
Signature of Applicant or Agent Tina Gracey
TARMAC CALIFORNIA P.O. Box 14050, Palm Desert, CA 92255 (619) 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 File On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs .�
Private improvements: 3% of estimated construction costs C G
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1222
DATE APPROVED 9/18/91
EXPIRATION DATE 9/19/91
DATEIS U 9/18/91
e,
2z;��
By.T1 Administrative Authority
TELEPHONE: (619) 564.2246
NOTE:
�
With proper validation
this form constitutes an CITY OF
LA QUINTA
encroachment permit
APPLICATION
FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
01, ►I$9ws
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 II I
DATE: September 18 1991
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' wide
green weight. All else legal
Haul Route: Durango and Martinez to
52 and out of city limits
DIMENSION OF INSTALLATION OR REMOVAL
Haul Date: 9/19/91
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 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.
Ci�?Aeey
Signature of Applicant or Agent Tina Gracey
TARMAC CALIFORNIA P.O. Box 14050, Palm Desert, CA 92255 (619) 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 File On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs .�
Private improvements: 3% of estimated construction costs C G
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1222
DATE APPROVED 9/18/91
EXPIRATION DATE 9/19/91
DATEIS U 9/18/91
e,
2z;��
By.T1 Administrative Authority
TELEPHONE: (619) 564.2246