1291NOTE: y _ —� C c)u
With proper validation J I
this form constitutes an CITY OF LA QUINTA
encroachment permit S
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
�oF
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 20, 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 Grinder, 10' wide. Haul Route: Bermudas and Durango to
_84.000 lbs, all else legal 52 to Washington and North to City `
Limits
DIMENSION OF INSTALLATION OR REMOVAL
Haul Date: 11/21/91
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 againstany 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.
`Tura P-A�
Signature of Applicant—di Agent T a 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 1 C-91
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. 1291
DATE APPROVED 11/20/91
EXPIRATION DATE 11/21/91
DATSUED 11/20/91
By.
dministrative Authority
TELEPHONE: (619) 564-2246
NO)?-:
Witg proper validation
I( 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: November 20, 1991
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Vpve Equipment
DESCRIPTION OF CONSTRUCTION Grinder. 10' wide.
84,000 lbs, all also 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)
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: Bermudas and Durango to
52 to Washington and North to City
Limits
Haul Date: 11/21/91 1
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 propee rty
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to rthis 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.
r r a &o .
Signature of Applicant Agent'i 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 r, On File
Contractor's License No. City Business License No.
On File On File
i
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 1291
4
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
1 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. 1291
DATE APPROVED 11/20/91
EXPIRATION DATE 11/21/91
DAT I SUED 11/20/91
By
Administrative Authority
TELEPHONE: (619) 564-2246
Mr -lo t
A® alga A® oiA1rD°v
Q�ilaal 3.11iQ 'ON womtl
UVQ NOIJVlirdX-j :1v101
(33AOa441P Uv00+41now 0
Dung Ajotn$.11110000 4ef3
N0111/0{1vA 1i>+��3d
Hlvurd
41d 1,ucii l
�p i+a ua 13+afu,
01�L °jAp'W1 o°tea1�"S,n+ "D — 1"wud 1uuu+ea,o ul ,ou1NF
� u0�3.7tULu49 A+lA1bRq �O �' ;{�,su„W,�,Dtw OIY�iid
oa<oo uo�U+u>tuaa D+lvvam
iD 7i� au++wtrtoowi �ilpnd
III aft — yyy�d u++t++�+a,auti uo.r A,p n
q S MIA
_.•._ +wwnH tii��ad
Au+Cu:o, wuvjnrul r.fural�aedr
• off °surrz t ffl�+lluo�
t"'VO Wa N ystn/ F3 _/ rRt�ir+0�
'Waft krP io ttnw rw ry n.r..a.y _
+IR4 Ktq+ Ir4 �A YWa.a +tA i� ruaUwao owa Fu hR "MOW � ,o
N 9O
jig w A..3
•t>� M IMy tUor wwM �
+�+ra ry M ttm,ulpq w W" let) A-rita.-o" tory d H►.ca�tnrr rul NIteN
,Wnc.e +v etw °ip q +wr�uty Oua+,6 111nw +4a..a..A w�vt.rorn ,
Avg p a+W 0. "v to y MMwowy
IM Fttt Afaa t IN+ p'0 0" '+y�Mpv Am# M Ute wl.ua Duo uaav Ulmm jo Maro wsy /rgtay emrl A fwunCwl 'wuryvd
�4 rr•wvry •wAq�puq P+• rsuaor.wdy •DHy •twMo arruout�v � •N19 +�A twp ON a,°i.e •�,y��l
Hquzy lut*,Idde tiq •lttluao p
'A le 94gtAt,d Ala i4 vonwopeauaA up
// � (a-uWaiisul} Ouol"dw x/put bt, qwl u+wawad Ovoild Out uotuvd
(� Il.i onvuJop Due '11}Lquy 1wooviatm Ila io IaAowrr bu�O�pul)
S 1203 N0u.:)nbl5rvo3 ®31vWI1S3
N011a1dW0, 3Q 3y1;131VNIXOdddV
/ Nl938'I71A1'TOM N3K% 3WIi 3.LVWX0dddV
v/� 03O33N 41 'NOilYAYOX3 JO UIS
��—r Uo 140""'O -UNI JO NOISN3w10.
s ��u�✓
t,
o,d bLSN03
f! °urp tao001.1 M
a�rWZ
N0L4nu-UN03 d0 350d1ind
-. AI »aq lrust� su 11im"Cadwl siwier NOl.1-AWSKn3 40 NOI.Mol
Ili �4N�411t°uaM,iU4k11 yatyAl %
SWI%IAIQvnS 03AOW44V pot SLN3i43A04dWl tION{w W* ua »uual to w►ia,awQ,Qurq a
drAelY lnyt '4taA"et 'tlol du}m,ad I+>llawpU 'Au+wve°d 'oAw�+Auq 'rgfro t1w4�d &A
1¢a'oMl 21Ian4 014 a+y0 puD
>0►+d 1D uoronnan,� +ul jai
IlN�W1l�MOIION j Nol1.O11uisNQO sxulom 011Q11d ,
IIWIl3d abd Nouvollddd
VINlno vi .4o Alla �'tw°Q fuw�eraaui
w Qa+a+so;,as uuey app
LION f
`r�� `'_� �� �rw �� �1 i .��� �III.II��1111 YO.— �✓»1)r�l� �. 11� � I�
i 0 d S"W to SE = S i QaM i 6 ON