1233r
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
Subdivision Improvement Permit— Class III
DATE. September 27, 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 30 ton crane: 10' wide; Haul Route: Sonora and Eisenhower to
"screen weight: all else legal Bermudas to 52 to Washington north,out
of city lmits.
DIMENSION OF INSTALLATION OR REMOVAL
Haul Date: 9/27/91
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) y
lr 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
A happening or. occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
j 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.
T`.�►"�/l� �l G C'.ea/
' Signature of Applfeaot or Agent
"TARMAC CALIFORi4IA 'P.O.'Box 14050 Palm Desert, CA '92255 775 -8267 -
Name of Applicant (please print) Business Address -Telephone No:
Name of Contractor and Job Foremari' Business Address Telephone No.
On File On File
Contractor'syLicense No. City Business License No.
On File On File
Applicant's Insurance Company Policy Number
FEES: Subdivi1. sion Improvement. Permit — Class 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 Mr $ PERMIT VALIDATION
Permit Feei~10.00 PERMIT N0. 1233
Penalty '
DATE APPROVED 9/27/91
Cash Deposit -Surety Bond
if required EXPIRATION DATE 9/27/91 '
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
DATE ISSUED9/27/91
By
Administrative Authority
TELEPHONE: (619) 564-2246
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NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT �
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)oFows�
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 27, 1991
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION 30 ton crane;_] 0' 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 I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Haul Route: Sonora and Eisenhower to
Bermudas to 52 to Washington north out
of city.1mits. ,
Haul Date: 9/27/91
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 Qulnta and to pay for any additional replacement necessary as the result of this work.
Signature of Apphealt or Agent
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. 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 1 233
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
Recorded by
Date
PERMIT VALIDATION
PERMIT NO. 1233
DATEAPPROVED 9/27/91
EXPIRATION DATE 9/27/91
DATE ISSUED N
9/27/91
By.
Administrative Authority
TELEPHONE: (619) 564.2246