1225NOTE:
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
Subdivision Improvement Permit — Class III
DATE: September 23, 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, Haul Route: 52 @ City Limits to
green weight, all else legal Durango and Bermudas
DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 9/23/91
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:
v
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 r
TARMAC•CALIFORNIA P.O. Box 14050 Palm Desert, CA 92255 775-8267` y
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 I �—
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
10.00
$ 10.00
Received by Date
PERMIT VALIDATION
PERMIT NO. 1225
DATE APPROVED
EXPIRATION DATE
9/23/91
9/23/91
DATE ISSUED 9/23/91
By—
IF
Administrative Authority
Recorded by 11 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)
C�`�OF Tf$9�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: September 23, 1991
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I 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' wide, Haul Route: 52 @ City Limits to
green weight, all else legal Durango and Bermudas
DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 9/23/91
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
Le Quinta and to pay for any additional replacement necessary as the result of this work.
T1i4a g2gty
Signature 'of Applicant or Agent r
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 Telephone No.
On File On File
Contractor's License No.
On File
City Business License No.
On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III t
Public improvements: 3% of estimated construction costs ,1 J
.Private improvements: 3% of estimated construction costs C
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
Recorded by
Date
PERMIT VALIDATION
TELEPHONE: (619) 564-2246
1225
PERMIT NO.
DATE APPROVED
9/23/91
EXPIRATION DATE
9/23/91
9/23/91
DATE ISS ED
By-- /fj
G�t�yydiY�
Administrative Authority
TELEPHONE: (619) 564-2246
SEP -23-91 MON 7:43 MAS P.01
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APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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SIZE OF EXCAVATION, IF NEEDED
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APPROXIMATE TIME WHEN
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APPROXIMATE TIME OF COMPLETION
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DAYS APPROVED
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EXPIRATION DATE
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