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12454» NOPE 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: Q? 10/8/91 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 E Loader. 9' wide. Haul'+Route:•• Durango and Bermudas to alL else legal .t 52 to Wahingron and out of City Limits DIMENSION OF INSTALLATION OR REMOVAL - Haul Date: A0/9/91 SIZE OF EXCAVATION, IF NEEDED '7 APPROXIMATE TIME WHEN WORK WILL BEGIN jr APPROXIMATE TIME OF COMPLETION ' ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris, backfilling, co,m, paction and placing permanent resurfacing and/or replacing improvements.) In consideration of the granting of this permit, the applieant;.he'rebyi'agrees to: 'Indemnify, defend and save the City, its authorized agents, officers,; epresentatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action andkarising 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,Qthcey a , Tarmac California P.O. Box 14050 Palm Desert, CA 92260 ;s"7.75-8267 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 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 , F,• 1 245 PERMIT VALIDATION PERMIT NO. 1245 DATE APPROVED 10/8/91 EXPIRATION DATE 10/9/•91 DATE ISSUED 10/8/91 By Administrative Auihority TELEPHONE: (619) 564-2246 Ala+rno3nr 1�n.af,r.u,pV AO o.owaod _iota ,q Orw�b G31 l 31Y0 'ON ldImell ' � 31V0 MC1llYl�id� ��Vt01 ' o3nGaddv 3140PannOy 11 DUOS AJfjnS•ltrloOiQ 41 0!;1lF1lioc AJI1u14 NO1I,YOJ�VA 1►b1,a3d I ++i liyij+d S +ad u0ma01ut ®x •InP+ a+ awtall NS :Al Ix _—V"4 luawfAo,ol lowyy a� Jsuq u0133lumuao oft+waa 60 %r :au. „oJaw fJeaud 4'`.rl,::1., ,:S,i: `!�• •.i .,r; �,., ,.r'.i.l';.,;".S.wiC, -a.': ;���• G' d W •YOIIt t �,!'.", K .t ti::r':'� 'fl%it;i. <.rew.w�ayw•r..n-...: �:.t..4 . . 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UI Ola Z@ d s anJL i 6-8 ..._—JL00 -I of - , v — -1 y NOTE: With proper validation this form constitutes an CITY. OF LA QUINTA U encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) C�oFTl�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 I I I DATE: 10/8/91 Mirior 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 950 E Loader. 9' wide. Haul Route: Durango and Bermudas to all else legal 52 to Washington and out of City Limits DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 10/9/91 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 Quints 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 92260 775-8267 Name of Applicant (please print) Name of Contractor and Job Foreman On File Business Address Business Address On File Telephone No. Telephone No. 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 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 PERMIT VALIDATION PERMIT NO. 1245 DATE APPROVED 10/8/91 EXPIRATION DATE 10/9/91 DATE ISSUED 10/8/91 By Administrative Authority TELEPHONE: (619) 564.2246 4 • , At. 11