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1312S�X,NOTE - With proper validation ii! = this form constitutes an encroachment permit CITY OF LA QUINTA .y I 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 SA Subdivision Improvement Permit — Class III DATE: 17116/Q1 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION Paver, 11'611 wide, green weight. All Elsa legal DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN Sketch (attach construction plans if appropriate) ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) _ Inconsideration of the granting of this permit; the applicant hereby agrees to: Haul Router 50th across from school to Washington, North to Pred Waring and East to Adams Haul Date: 12/16 or 12/17 1 day only ,x- yf y 00 r' APPROXIMATE TIME OF COMPLETION or 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. 0 a o_iq cc Signature of Ap 'i nt or Agent 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 Contractor's License No. On File 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 Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. 10.00 $ 10.00 Received by Date Recorded by 1312 PERMIT VALIDATION PERMIT NO. 1312 DATE APPROVED 12/16/91 EXPIRATION DATE 12/17/91 DA E SSUED (16/91 i By Administrative Authority TELEPHONE: (619) 564-2246 NOTE: 3 40D -S r J, With proper validation + this form constitutes an CITY OF LA OUINTA encroachment permit APPLICATION FOR PERMIT Ig PUBLIC WORKS CONSTRUCTION (ENCROACHMENT). OF I{189 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: 12/16/91 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Description of Location) PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION -Paver., 11'6" wide, _green weight, All Else legal DIMENSION OF INSTALLATION OR REMOVAL Sketch (attach construction plans if appropriate) Haul Route: 50th across from school to Washington, North to Fred Waring and East to Adams Haul Date: 12/16 or 12/17 1 day only 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 end 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 10 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 Le Quints and to pay for any additional replacement necessary as the result of this -work. Signature of Ap'OfAnt or Agent 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 Contractor's License No. On File 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 $ II 10.00 Permit Fee PERMIT NO. 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