1296Ll a -�
i9TE: c
.�"W^ifFi� proper validation
,this form constitutes an CITY OF LA QUINTA
encroachment permit !_
APPLICATION FOR PERMIT +
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
.For, the construction of publric 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
- DATE: November 22, 1991',
LOCATION OF CONSTRUCTION
(Street address or Description of Location) 1
PURPOSE OF CONSTRUCTION Move Equipment
Minor Improvement Permit Class IV.
Sketch (attach construction plans
ppropriate)
DESCRIPTION OF CONSTRUCTION Kamastu PU Backhoe Haul Route: Washington &'Vred
11'10" Wide.'15' High, Purple Weight (130,000 - Waring to lighland Palms & on to, r
140.000 lbs) E Highland Palms i
i
DIMENSION'OF INSTALLATION OR REMOVAL
Haul Date: 11/25/91
SIZE OF EXCAVATION, IF NEEDED :.
APPROXIMATE TIME WHEN WORK WILL BEGIN .
APPROXIMATE TIME OF COMPLETION
t
ESTIMATED CONSTRUCTION COST $
(Including removal of a ll -obstruction, materials, and debris, backfilling, com- }
paction and placing. permanent resurfacing and/or replacing improvements) + 'j
In consideration of the granting'of thls'permit, the applicant hereby agrees -to:
Indeninify, 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, propeety
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. `
t Signature of Ap Qi nt or Agent Tina Graceq
Tarmac Caltforiiia P.O. Box 14050 Palm,'Desert, CA 92255 775-8267
P Name of Applicant (please print) Business Address Telephone No.
}
Name of Contractor and Job Foreman Business Address TelephonelNo.
On Filer On File
Contractor's License No. City Business License No. -.*. .
Qn 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
t. Inspection Fee $
Permit Fee '
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
10.00
$ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT NO
PERMIT VALIDATION
1296
DATE APPROVED
EXPIRATION DATE
11/22/91
11/25/91
DATE ISSUED 11/22/91
By
Administrative Authority
TELEPHONE: (619) 564-2246
131111111111
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NOTE:
With proper validation
this form constitutes an
encroachment permit
x.04
CITY OF LA QUINTA
APPLICATION FOR PERMITsW
s
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OF
7118 �S
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 22, 1991
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment
DESCRIPTION OF CONSTRUCTION Kamastu PU Backhoe
11'10" Wide, 15' High, Purple Weight (130,000 —
140,000 lbs)
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
ARPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Haul Route: Washington & Fred
Waring to Highland Palms & on to
Highland Palms
Haul Date: 11/25/91
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 124) 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 Ap nt or Agent 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.
Qn_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 I r_. ? _)
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. 1296
DATE APPROVED 11/22/91
EXPIRATION DATE 11/25/91
DATE ISSUED 11/22/91
By J
Administrative Authority
TELEPHONE: (619) 564.2246