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NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
t r ) f
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?,L0--7
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 andIAPPROVED SUBDIVISIONS
,DATE: March 6, 1992
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION _Move equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Paver 11'6" wide 84,000
lbs., all else legal.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Route: 52nd at City limits to
Bermudas and Durango.
Date: March 9, 1992.
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 or Agent
Tarmac California - 775-8267
Name of Applicant (please print) Business Address Telephone No.
P.O. Box 14050 - Palm Desert, CA 92255
Name of Contractor and Job Foreman' Business Address Telephone No.
On file
I
Contractor's License No. City Business License No.
On file "
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction cosis
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ II
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
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PERMIT VALIDATION
PERMIT NO. 1376
DATE APPROVED 3/6/92
3/9/92
EXPIRATION DATE
DATE ISSUED 3/6/92
By
TELEPHONE: (619) 564-2246
Administrative Authority
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NOTII1 1\
With proper vellda<Ion
ahl• toren apnatlautea o CITY OP LA t,U1NTA
aohmanc permla
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (BNCROACMMENT) se—
Per the "201-17 p
en ru Ptlonof publlo prl.— urbs, drlvewaYs, pavomonts, .1—.6k.. parking 1--, aow r•, wn[.r —.In.
end other 1111c publlo Werke Impro om.nts In connection with MINOR IMPROVEM-NTS and APPROVHO-U-OlVIS10N6
OATS: )Neral. 6. 1992 Subdlvlolon Improvomont Permit— Claaa 111
Miner Imp' --t Permit Clqu IV
LOCATION OF CON6TRUCTION
wtr•rt ad.... er P..prlPelon .at Lpo.afonl
PURPOSE OF CONSTRUCTION —MOVe uisPtwxtL Bkaaeh (ettanh oons[rua[lOn plane If appropriat.)
O8-CR.IPT�C�N OF OONt3TRUCTION Pever 11-15"tide 64_000
1be_elwo leIIai. ltoutea 32n1 eC City liPtiCs Cp
HeYIDLld6e QO.
OIM■NOION OF INBTA ELATION OR REMOVAL eta4 Doren
Duet bi—ft 9. 1992
1912■ OP -XCAV A71pN, IP NEEOEO
APFROXIMATB TIMH WMHN WORK WI LL BBOIN
APPROXIMATE TIM@ OF COMpL6T10N
IIBTIMAT60 CONSTRUCTION COST O
(t nelur/ing remewl 01all .obaeruotlo n, r erlela, end debrl•, b.ekt!ll Ing, oom-
Pootolen and Placing Permanent rnurfooing end/or —16.1n
p Im Prpvam.nxe)
In o alderselon Of the 9—Ing sof this 0—mit, the apP11-1 hereby epr.aa tel
ind•mnity;•tl•f•ne and .eVIn. Clty 1aa • thprl. •�•nt., ottlo•r., r Pr•w n<a 1— a— a h end • fir• I
<ls.. Ilsbinxl•a tar Ips s r sultlne Prem cities. a alPn .nd srhln0 Put nY lo.. o m.p. t �w n. r Pr Y
rpt.PP•n lnp Pr attrrl na a . ro. mea u v.or4 Vntl•rt•Y•n —4.1 he —1-
12 1
mit(241 hear. In •tlVanea of [h• tlm•nw Prknw el b•
Vomp1Y with all •PPlle•bl• DItyP Ortlin.n••., the <e m •nd opndl<IPns PI tit. P••m It end all .ppllp.bl• rV l•. •ntl r•aVlatlon. Pf an• OIN Pt
La pulnt• entl to PSV fpr •nY •dtllt 1pn•I re Pl•eom•nt nee•.aerV as the r.autt .. th1. werY,
TRANSMISSION REPORT
THIS DOCUMENT (REDUCED SAMPLE ABOVE)
WAS SENT
** COUNT.**
*** SEND ***
NO
Blgnatur. of Appliesnt or Aga nt
Te rmen CelifPwn ie
775-8267
Nam of Applicant (please Print)
Bual na►a Addr.m TeloDhena No.
P.O.a Hos 14030 _ Paita Deoert
CA 02249
Name of COntrector and JOB Foreman
-ualmu kdd,.— Talaphon. No.•
On Yile
Centreetor•a U—.. Ne.
QlW 111-1—so L-1—it. No.
On time
Applicant•• lnauranba Company
Pcoloy Number
PIIHBr Bu bdlvlolen Imorovemant Paresis — Clgas I11
Public Improvements: 9% of o•tlmat.d Ponstruotlon
coats
Prlvete Improveme ntsl 3% 01 eetlrrta<ad cons
ruction a r E.a
Miner Imorpve mane Permit — Clau 1 V: Bee ecu ohad aehedulo
Inas etlon Pea Q
PERMIT VALIOATION
Paresis Pa. 10-00
1976
Penalty
PERMIT NO.
Cuh D.Poal-4ur.tY bond
OAT- APPROVED 3I6i92
If r.qulrad
.
1000
HXPIRATION OAT- 3/9/92
TOTAL: 6
OAT@ IBBUEO 3/6/92
Reoslpt No.
ReeelVOd bV De[a
BY
Adminl•trative Authority
R000rded by
TELBPI•IONBI (619) B64-2446
TRANSMISSION REPORT
THIS DOCUMENT (REDUCED SAMPLE ABOVE)
WAS SENT
** COUNT.**
*** SEND ***
NO
REMOTE STATION I.D.
START TIME
DURATION
#PAGES
COMMENT
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