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1223NOTE: 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 b'ATE: September 19, 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 950 Loader 10' wide 15' high green weight Haul Route: Washington and Fred Waring to 52 and to Bermudas DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 9/19 or 9/20 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 torpay for"any additional replacement necessary as the result of this work. Signature of Applicant or Agent TARMAC CALIFORNIA P.O. Box 14050, -Palm Desert, CA 92255 (619) 347-5414 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 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 10.00 Penalty Cash Deposit -Surety Bond if required TOTAL: $ 10.00 Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. 1223 DATE APPROVED 9/19/91 EXPIRATION DATE 9/20/91 DATE ISSUED 9/19/91 By Administrative Authority TELEPHONE: (619) 564-2246 r: m n SEP-19—'91 THU 11:55 MAS p @1 ' i, '� r� "'� `•'�-e i� �..r.�. w.F �� ..4 yrs �� � f ' NOTE: Vft prow. "14*wn 7, this farm eDrs uM, an from ,Rymrt oarm t Cm OF LA OUINTA 9N APPLICATION PLIBUC WORKS CON.ST'Ru(;TION (' I:NCR©ACJ'1MF.NT) For the mut voIlort q} au6diQ Or Prrvato I++nbe, tlrrvewevt,va and other like "ie vratte t�"Mu in ao"n►cason Wlth MINOR iM OVEMEINTS.nd�APkkwP r►9 (Ot1. fewer*, _ ROVED StUBDIVISIIrtw Of � DATE: • � ' Suhdivieior+ IMp,,Oven a tOG4TI0N F CON I}�t0 Atlnor Impnonmetn `ClNr 111 N .06 t IV Iir'r.r r,.mr. or ore,Qay,t Love.r�t ' . ;,'} • . PURPOSE OF CON ' S7RlJCT70N S4.etr, ferndt .: ,. D 51PrIIN FtOMST mai Werq' e DIMENSION Of tNSTAIp•,kTIOA! OR REMOVAL �real ala, St2E OF EXCAVATION, IF NEEDED APPROXIMATE TIME MIEN? WORK WILL BEGIN 9 � APpgOXIMATE TIME OF COMPLETION ESTIMATED CONSTRUC7tON Ilna„di ry COSTS rnovel of ell 061111tccon• r►+am als, en0 deblx, ba�tfillP j Putlan and1a ne n In tons,den onGn9 Dernti � end/or np4tanq i►narownl�) a ® .';�•, � of the tJr'anting of ME, Dermot, the ea eaoir�nt hers e t t"a.rm,,rv, a 0v oree'e to. , m«+o aht taw qr Clry. moc eoa+aure aarrw, eMiQ.rp, no ��•I �'` �' '', ' � OrrV�►rrr• IHpihfrfe er 1eq rryrenl IrYrr, arM mum aetren arra ersN,e alf[ erMrt N of"of"0rMw lun+� fmm one "r^�^I Or OQwyvy's • QepN.rwM ewR e} erre rrory rrra Bret. for er MnrMj y.a ~ e11' µetch mf Aen,rm,�, Auban roar. ttr pnIt t prmrs rmrm oart eo Ohio rPprrltrarr, fit► ... ; . + v4r v baeo -oftw•ur 1$ai Aeon, to *on,%* of 6Aa trw *moon WM Wool be ears. Li iWlnb anp tD UIv tqr acv au0r►*a:� rreVblerKM h�deworY � m,wot •rrthe ��N M�OPf t M,rlilble Ya'I ft"""W.w of 0" 91tv �• .,:?ate.^,yv.: ;r� 1 5IrMut a of A I,eY1t r A6"nt ?' NerYu of AOA+runt taleale ter�ntl ` � � •`;..' Swint, Addrou �•• Tolson" Nart,a Of COntreCtpr y" Q f "t'" BuunM Address •"''r;'. Tete Contractor f l,unsf q_ t�• . No' ' . !'r1 .�l'e' .c. �: '.fry' .� !.r. .;xE:�a• }: lJi � t.,antmt ,'� :.:� .a,. •sY;.: �y�' :m C .naymrenae'Cerr,pr; ,,. .,,.....r ...._ _ ' >"�u'.::.'.,.0 I'. •.' ,I� y., li li'rJ U'Tl tiff _ FEEg, . i :�:' .•`Iry �a1.rt, ..r. ,Syb.dlVf 40n' =Y.. ,:'t', _ _ d I rn . iwY r�i a+.:uii.:. CUD tI1 Y •;pYY 4",::N.t• C' ex{x►ruted 5. vs cont moron clt ra Private rmprQ'remrnte: 3% of RltJrnitaa OonIStVmOmI taeS6 A � Minor tmorovtnrcnt Pcrmrt .. G+n IV; j� a I s"etUcr.o sehedure a� t r t. rneofctlon piorn,rt Fre PERMIT VALIDATION t Penalty �SRMIT t:0, I Cash D,,Mjj,SufM Bono if faoyltec DAi•E APPROVED TOTAL: EXPIRATION DATE I Aearot No. DATE ISSUED t 01MNOO by Dits By Ilrpordec by Admn,atR _ I TELZPhONE:16191 D644246 _ i 4 .? 34 0 L ---------------------------------------------------- NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) OF 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 I I I DATE: September 19, 1991 Minor Improvement Permit -Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) f PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION 950 Loader. 10' wide 15' high green weight DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Sketch (attach construction plans if appropriate) Haul ,Route: Washington and Fred Waring to 52 and to Bermudas Haul Date: 9/19 or 9/20 One Day Only APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris,.backfilling, com- pa6tion 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 parsons 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 end conditions of the permit and all applicable rules and regulations of the City of La Quints and to pay for any additional replacement necessary as the result of this work. Signature of Applicant or Agent TARMAC CALIFORNIA P.O. Box'14050, Palm Desert, CA 92255 (619) 347-5414 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 I I 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 Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by .Recorded by 10.00 $ 10.00 Date 1223 PERMIT VALIDATION PERMIT NO. 1223 DATE APPROVED 9/19/91 EXPIRATION DATE 9/20/91 DATE ISSUED 9/19/91 By. dministrative Authority TELEPHONE: (619) 564.2246