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1284MOTE: r With proper validation this form constitutes an i encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 0 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: November 13, 1991 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION — Move Equipment DESCRIPTION OF CONSTRUCTION Bros. Grinder 10' Wide. Green Weight.' All else legal DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Sketch (attach construction plans if appropriate) Haul Route: 52 @ Eastern City Limits to Bermudas and Durango Haul Date: 11/14 or 11/15. 1 day only '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. Signature of Applicant o ent Tina Gracey Tarmac California P.O. Box 14050 Palm Desertt CA, 92255 775-8267 Name of Applicant (please print) Business Address Telephone No. K 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 PolicV Number FEES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs •q Private improvements: 3% of estimated construction costs , 1. Minor Improvement Permit — Class IV: See attached schedule Inspection Fee Permit Fee Penalty Cash Deposit -Surety Bond if required 10.00 TOTAL: $ 10.00 r Receipt No. Received by Recorded by Date PERMIT VALIDATION PERMIT NO. 1284 DATE APPROVED 11/13/91 EXPIRATION DATE 11/15/91 DATE ISSUED 11/13/91 By Administrative •Authority TELEPHONE: (619) 564-2246 3 x; .. �� . i. .. �� ..�. . , of�-,'491eto1 �►vOf+d3't�l .. 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' 111 dFp � LWJrd JLtwMloxlWl uQINAr�M / �3111Q 'fV9 r MIStA10onS 03AOUddV"UN3W3A0U041 VONIW 1,01014 UO=4uuco u �a �4ant •r+rrw{ •n� 8v�x4r6 •e r•Ap• I• ' 1 w1 e>� �Ipnq r,I,l +cyto pulp >f p >w+ewoArd '%�9*"jjp •ta4na 11"46 +O *9Q. ;q SOT wI +03 UN3iNWV0td0ry3) NouznulsNoo sxvoM mend llWW3d 1;103 N011=1d4V VIN= do Alio a+W+.o W�urprngM• we raaw„oa "w Era ' �rPw woe+o �+AA ;UON • T 0 d Std W 0 T Z T Q3M T 6-2 T — "PN 0N -a>q c.)y NOTE: .� With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) ' c�'`yoF �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: November 13, 1991 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION Bros. Grinder 10' Wide. Green Weight. All else legal DIMENSION OF INSTALLATION OR REMOVAL 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: Haul Route: 52 @ Eastern City Limits to Bermudas and Durango Haul Date: 11/14 or 11/15. 1 day only 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. �Oq GLA C Lel Signature of Applicant o nt Tina Gracey 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 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 1?�4 PERMIT VALIDATION PERMIT NO. 1284 DATE APPROVED 11/13/91 EXPIRATION DATE 11/15/91 DATE ISSUED 11//13/91 By I.txiU Administrative Authority Recorded by 11 TELEPHONE: (619) 564.2246