1255NOTE:
With'proper validation
this form constitutes an
encroachment permit
r
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-SUBDI,V•ISIONS..,...,-.,,..,
,r
DATE: October 15, 1991
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION Grinder, 10' 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 III
Minor Improvement Permit'Class IV
Sketch (attach construction plans if appropriate)
Haul Route: Washington .at 111 to 52
and on -to Bermudas and Durango
Haul Daee: 10/16/91
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'a�hcl 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 ApplicaNnIlDr Agent . Tina Gracey
TARMAC CALIFORNIA P.O. Box 14050 Palm Desert, CA 92255 347-5414
Name of Applicant (please print) Business Address Telephone No.
0
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 1 255
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. 1255
DATE APPROVED 10/16/91
EXPIRATION DATE 10/16/91
DA SSUED 10/16/91
By
Administrative Authority
TELEPHONE: (619) 564-2246
OCT— 1 6-9 1 WED
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Manea►rrrtrn«n,K CITY OF
LA fzulNra
APPLICATION FOR PERMIT
PUSUC WORKS CONMUCTiON (ENCgOa MEAfT)
z
For the oonsyyc.,or, pf Public oP
and other like Put�lic MrN*s i Davit! curtsa, dtryoweye, plvernerrtt, tid"Oks, Perin
h+wawn,rrr l In eonnemon Wall MINOR IMPROVEMENTS And APPROVE*� fttt m
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rTMK — CWe 111 •`
LOCATION F C,ONSTR ON Mlemtr Imarownrern PMnn C41t IV
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PURPOSE OF CONS-I'RUCTION
0 PIPTION F CphSTT4UC'noN v Skean Iltvds a ltrudtioh fills a 7'/e,
k
DIMENSION OF INS�LLAA-nnoN I
SIZE OF EXCAVATION, IF NEEDED .., ��,� �� ��D,.�►�J►2��' •
APPROXIMATE
TIME WHEN 4ii0RIC 1YILL, BEGIN
APPROXIMATE TIME OF COMPLMN � ��� ✓
ESTIMATED CONSTRUCTION CO$7 i
Qndudinq nnw.el of III Pbst7tatCpny r+ratsnala, and debne. bldtHlli
Ncoon and Placing Mrmir+erR Iyi,A•fy n, atm
In tonj,dentrpn of the m r � 1r'd/or hptecanQ impr0yprenpt! t � tT,•;,;•.
t t>7� Ierrn,rf, tf,f IDDlicant hirtby sgraC,I t07
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ae CItY, to iVir r
Dmpv#Aw I,ep,lAtAer b aoror vault" bvm eiewl w won'4"19A er,q era erb imDwv�. Mnr„ey from aim apso a a�
h°a+oa„nt or o'Rw.q r I awv►ww.w�rt nr KM eue N Iwv oo OW4. ksr e+ M'!'ll •`
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Policy Numoer
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ate Impp�yypng;
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Minor Imotov*rnrnt Pffm,l — Cu IV;0
�S" It MV0 11M#dule
rn%c*cilOn i•tr 3
Ptrmlt Fev PEAMIT VALIOAYIDN
Denrlsv ne RMIT 't0,
CU+ AeootJt•Surety Gond
If+eounea DATE APPROVED
TOTAL: EXPIRATION DATE
AK+riot No. DATE ISSUED
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By
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NOPE:
With proper validation
This torm slahmant permit const routes an
roe Ch CITY OLA QT
F UIN^
Onc
APPLICATION _ FOR PERMIT'
PUBLIC WORKS CONSTRUC'Y'ION (ENCROACI-IIb1ENr)
Por the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains i
and other like public work& Improvements In connection with MINOR IMPROVEMENTS and APPROVEO SUBDIVISIONS !
Subdivision Improvement Permit — Claes 111
BATE:- October 13, 1991 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Oescrlptlon of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION GL -r tr�/ii. 10, SAI—A-- g�-raaa uaui Stouts: Waakainacott at 111 to 52
are _2. et t eta'® t coxal nad an Lo Box-mtadwo mad Duraago
DIMENSION OF INSTALLATION OR REMO`✓AL H®u1 Dnt®a 10/16/91
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction, materials, and debris, backfilling, cam-
pactlon and placing permanent resurfacing and/or replacing Improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnifv,.defand and save the Cll%,. It. such Orlsetl agents, CfT1o9Is. raprsaentativea and employees, harmless from and agPlMt env and p }}If
Paheltlosr
, I:abllltfes or loss esultlna fron, elmim• o at
court alon one orlelna cut of any accident. los. or demaae to person• or pro}tv
ho opening or occurring as aProximate result of any work undertakon under the permit granted pursuant to this ap Plloetlon.
Notlfy the Adrnlnlce retive Authority at least twentvfour (24) hours In advance of Lha time when work will be ctortod.
COm PIY with ell &Poll—lel. CltV Ofdinanoos, the terms and of the permit and all applloable rules and reauloti— of the City of
La C u,ff— and to pay for env addltlonal raplaaomont necessary me the ro.ult of this work.
ek ��SjiJERI_S'e.d\/
Slgnaturo of Applica r ^gene W-1 a Graa.ay
Tet= I C CALxx!0RN2A O BQx 14050 Pnlm Dasfert CA 92255 347-5414
Name of Applicant (please print) Business Addreas Telephone No.
Name of Contractor and Job Foreman Business Addrass Telephone No.
On Fila On F3ia -
Contraator'a License No. City Business Lioanag No.
On 711& Ora Fiie
Appllcant'a Insurance Company Polley Number
F1218B: Subdivision Improvement Permit — Class 111
Public Improvements: 396 of estimated construction costs
Private Improvements: 3% of estimated construction doets 1255
Minor Improvement Permit — Claes IV: Sae attached schedule
Inapactlon Foe 0 _ II PGRMIT VA LIGATION
TRANSMISSION REPORT
THIS DOCUMENT (REDUCED SAMPLE ABOVE)
WAS ' SENT
** COUNT **
*** SEND ***
NO
REMOTE STATION I.D.
START TIME
DURATION
#PAGES
COMMENT
1
6193427504
10-16-91 12:09PM
1'13"
1
TOTAL 0:01113" 1
XEROX TELECOPIER 7020