1264NOTr:_
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: October 25, 1991 Subdivision Improvement Permit — Class I II
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 Cat Grinder, 10' Wide,
Legal Weight
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Haul Route: Washington at Fred
Waring to 52 and to Bermudas, moving
back out 52 to City Limits.
Haul Date: 10/28/91
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 Quinta and to pay for any additional replacement necessary as the result of this work.
e-2, %
Signature of Applicant o\r,6ent A.
Tarmac California P.O. Box 14050 Pa1tn.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 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: $ IO . O 0
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1264
DATE APPROVED 10/25/91
EXPIRATION DATE
10/28/91
1264
DATE ISSUED 10/25/91
By
Administrative Authority
TELEPHONE: (619) 564-2246
i
0
OCT — 2 5— 9 1 F R I 15:47 MAS P.01
NOTE:
With Drops nadt,seeR i
the form eanetrtuya in
enaeecnrennt p=,t CITY OF LA OUINTA
APPLICATION FOR PERMIT
lo PUBUC WORKS CONMULMON IENCROACHMENT)
For the eonitn,
Ong other like puWc o! A410, bliC or prrvste euros, drvv°weyt, Wvemerrq, /,tlelylke, perkf
ng
Woelte tr"mea'e^w+rp In eonnecnon With MINOR IMPROVEMENT entl AP *U' rpt, *ROWq�bli•.
PROVED'suIIOIVI=1c
GATE• "'y ��, "' ��-/ •s�divllior, fmtfrpgnw
LOCATION OF CON Minor ,--��.,• nt Psn"M _� 111
Minor fmprpte %4nnrt CIM IV �~�
I$~ aadnrar a
tlew�ow of t.aeaeaenr '
PURPOSE OF CONST'RUCT'ION ,
C RIPTIaN fJFe UCTI N 5lcecch {etOtoh
�-- �b'ue:tion
_/ . trlene n<e�
X",
DIMENSION OF INSTALt,AT10N OR'
'AFMOVAL
Ct f/'e� Thar/', %c
SIZE OF EXCAVATION, IF NEEOED
APPROXIMATtE TIME VMEN
WORK (MILL BEGIN �q
APPROXIMATE MIME OF COMPLETION
ESTIMATED CONS AUC�ON 8'i
.r% {
IIAOudieq rerr►ovel °r ell
pe Dlean
"an Intl ° uor+on, aretwk4ll, and debrn, t►edcfillinq, cor»�
p pem4+rm e*etafea n and/or rvplecing irnoroveme")
In conerdereaon pf the u'+f! of g
fif pa:rmrt, the applicant heretry egryetr to.-
the
o:the Gh, W wn,.,.d
aa'N'►mss• I+sturnrae a ►a.0 eano, eHk", r+a�wwnrr♦rin¢ s d wft'wom, hemM.a Mrn eti
+�dn! *an ae+rw w Dawn acuon *no oh" eut e1 wry eoCbraen, ►oea or �"" ✓M •ql aN
na,,,M « twa,me,e a aer.na�
Notch the Aon�nsyy� Au r..rn of Mry waw Ynaawae unser trio *wrw,t
'it
eQ owN►►r+t b this
tfwi,n w 1wt ra"e1+ r wreira or tlaeeyrie�
tvw►+ty-0ow 1741 1Myn 0 ��+.
t%anely w"rw els eeao�e G eUveiwt N dfa bff* 1M►en ew e{ "al to ft"M • ' . "° • �
(.r Or,no em to ow rw Mti tlitipr� +► r+.nt � a,rh °nw�ni of w eao��m" N'"i1 ef'm "W1n!* °1 trw dw w
v
Contractor 1 L,Cen►e No, 4—
n'1f FEES:
y j a ButineL Lia 44
rr•td. J% of etvrn.t.d oonmueuon eoett
private lmproolh terra: 3% of etuntatea Construction costa
Minor Ihmoroverhent Pem, _ Cu !V. Sm ettid►ed ery,bure
►ntotetion Fee s
per►nit Fee
Peneity
Leah Oeoont-surety Bono
If required
TOTAL:
Atroeipt No.
poupw6c by
A�tiea by .
No
PERMIT VALIDATION
ne RMIT .':O,
GATT APPROVED
EXPIRATION DATE
DATE ISSUED
By
Adnvn�AYe '
T8LCP6Mr-- I6191 6RLr,.. Y _
•itV With proper validation
Wi
this form constitutes an
encroachment permit R STA "
ERMIT
PUBLIC I (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: October 25, 1991
LOCATION OF CONSTRUCTION
(Street address or Description of,Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION Cat Grinder. 10' Wide,
Legal Weight
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Haul Route: Washington at Fred
Waring to 52 and to Bermudas, moving
back out 52 to City Limits.
Haul.Date: 10/28/91
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.
T" C!_V Q f(n ctz
Signature of Applicant o ent
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 III
Public improvements: 3%'of estimated construction costs
Private improvements: 3% of estimated construction costs (j 4
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
Date
PERMIT VALIDATION
PERMIT NO. 1264
DATEAPPROVED 10/25/91
EXPIRATION DATE 10/28/91
DATE ISSUED 10/25/91
By
Administrative Authority
TELEPHONE: (619) 564.2246