2100i
NOTE: r
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
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: 3/14/94
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment
DESCRIPTION OF CONSTRUCTION paver 1116" W. 84,000 lbs
All else 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
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:
Sketch (attach construction plans if appropriate)
Haul Route: Alvarado, Montezuma
Eisenhower, Ave 50, Washington St,
To North City limits.
Haul Date: 3/14/94 or 3/15/94
One Trip 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.
. Z_4' /- /a— _*) /L,
Signature of Applicant or Agent '
Granite Conatruction 38-155 Monroe St. Indio 775-8327
Name of Applicant (please print) Business Address Telephone No.
Same
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 t
Public improvements: 3% of estimated construction costs '
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 14
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
r
2100
PERMIT VALIDATION
PERMIT NO. 2100
DATE APPROVED 3/14/94
EXPIRATION DATE 3/15/94 y
DATE ISSUED 3/14/94
By
Administrative Authority
TELEPHONE: (619) 564-2246
Ti;
I.To
r MAR -14-94 MON 10;24 PM
44
NOTE:
With propaf validation
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CITY OF LA QUINTA
APPLICATION FOR PERMIT
-PUEI.IC WORKS CONSTRUCTION (ENCROACHMENT)
P, 2
For the aonstriution of publlo or privexis Curbt, drlvtwtVt. PAVeMents. sidewalk&, p tlftg lot;, sevwon. water nulns
and outer Ilk# public work& imprpvenrnb In aonnomon wilts MINOR IMpA0VEMENT8 and APPROVED SURDIV381ONS
DATE: ` Subdivitian improvernent Permit . Clea III
Minor Irrlprovemont Partin CIM IV
LOCATION OF CONSTRUCTION
IiNwt sodre,s «Cst�arttrtton a t.ovatlllf►I e
PU"031 OF CONSTRUCTION
Ski e��tatvdt wruwgglon plans it apprMiatal
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEOED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ISTIMATEO CONSTRUCTION COSTS
(Including tamoval of all o0s"man, matoriaFa, and debrls, badtfiliirp. gom.
Wtion and Placing PU Manant resurfacing &n&gr rg0taCing improvemenul
S MoFa111r>ltion of the 9nnting of wa pewot, the applicuMt hfireby oprms 10:
Irderm+h, defwnd am NYe the City, its Mnonsa0 aquas, ottim", rarmntauvn cad ar4wvow hatmim from am allaM Lw and all
O/n.tft88, Itabilitir w (be rewlting Item cia+ms Or teuft aettoe " 66whe Out of Inv aca+aartt, ton a *afi►9e to aerwa of f>rvonI
mv
or oOCi mdq al & ismag a conn of amt► wore u/+owl"en slow the oannrt firanted OYroul►ht is fits 1ppiitmum
Notify the AGMAOInIt Ye Autfi njV at krsK tvwnevtatt (24I jXw" ra IQvarfir N free tlt�e f1MfIM MrOA WWII ba
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COn+Oy tMC! IFI adpilcaaie City Ordlrfaaroat. the Mm" eha eonaitw" of fife Oennq Ib all "91j We rytp arw rgWl %Wd of site Cap of
L4 Quin• and to Dab for my owltbnr mpeadwnottt neakmoy N tits rewit of <ra tom,
Yams of Applicant (10me print)
{+me fit Contractor and b Foremen
?�tuutort L,-isrm No.
oplicant's Insumnal Comoany
Appli=nt ot,A
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Telephone No.
Susirw a Addrou iphOM NeFs.
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MAR=14-94 MON 10;23 PM
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COMPANY NAME: - iAX NO: �/ /' /71G'
FROM: FAXED BY:4-
PAGE 1 OF
IF YOU ZXPERIENCE .ANY DIFFICULTIES FROM FACSIMILE (519) 342-7504, PLEASE
CONTACT SENDER AT (619) 775-86M.
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axm 619/360-4500
FAX 619/3604570
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NOTe i
With proper validation
th lg form const ltutos an CITU OF LA GUINTA
enaroachmont permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONISTRUCT.ION (ENCROACHMENT)
For the construction of public or private curbs, drivewa•
and other like public works Improvements In connection with
Pest -It^' brand fax transmittal memo 7a71 M pf peoee ►
roan
e
GATE: 3/14/94 ap ti
LOCATION OF CONSTRUCTION a rte- lslgp� I Pea
(Street eddreos or oeseriptlonof Loeetlon) ---------- ....... _._....... ..........._ _.
PURPOSE OF CONSTRUCTION Move.' Equipmaat Sketch (attach construction plana if appropriate)
OESCRIPTION OF CONSTRUCTION PBVar 11-' 6" W. 84.000 311—
All al � iso<ai __ __ Hnasi Route, t Amar aBo . Moat�a;auna
Eiaanhotaar. Aver 50. Waahiagtoa Sc.
DIMENSION OF INSTALLATION OR REMOVAL To North City 11te1taf.
SIZE OF EXCAVATION, IF NEEOEO
Sabi Datet 3/14/94 or 3/15/9.4
APPROXIMATE TIME WHEN WORK WILL BEnIN
Ono Tr1p Oaly
APPROXIMATE TIME OF COMPLETION
1=9TIMATEO CONSTRUCTION COST 9 '
(I nctuding removal of all obstruction, materials, and debris, backfilling.
poetlon and placing permanent resurfacing and/or replacing Improvamonts)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indarnnlfy—elefend and sa.re the City, Its authorized soents, officers, •sprees ntetivas end employass, harmless from end against any and fil
panaltlee. Ilebllltla, or Icss resulting from clgime or court action and *rising 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 oranted pursuant to this spolloatlon.
Notify the Adminlatretiva Autherlty at least twenty -lour (24) hours In advance of the time when werk will be started.
COrnply with all appli—ble Clty Ordinances, the terms and—111iona of the permit end-all eppllcsble rules and regulations of the City of
Le Quint. and to pay for any eddltlonal replacement neoeadary as %ha result'of this —rk. .
is
Signature of Appl[cant or Agent
Qxcolmita COaatYtl *,!U—i 1—A4o 774�A477
Name of Applicant (please print) Business Address Telephone No.
Sema
Name of Contractor and Job Foremen Business Address Telephone No.
On H•31a Ott S ;1a,
Contractor's License No. City Business License No.
Oa P'11a On File
Applicant's Insurance Company Policy Number
PF -ES: Subdivision improvement Permit — Claes I I I 1
Public Improvements: 396 of estimated construction costs
Private Improvements: 396 of estimated construction coats
Minor Improvement Permit — Class IV: See attached schedule 2100
Inspectlon Fee $ I PERMIT VALIDATION
Permit Fee-,- -_-: 10.00 I PERMIT NO. ' 1I
Penalt'v I`3/14/94
GATE APPROV EO
TRANSMISSION REPORT
THIS DOCUMENT (REDUCED SAMPLEABOVE)
WAS SENT
** COUNT **
*** SEND ***
NOI
REMOTE STATION I.D.
START TIME
DURATION
#PAGES
COMMENT
1
3-14-94 1:56PM
1'09"
1
TOTAL 0:01109" 1
XEROX TELECOPIER 7020
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
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: 3/14/94
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment
DESCRIPTION OF CONSTRUCTION Paver 11'6" W. 84,000 lbs
All else legal
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class I II
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: Alvarado, Montezuma
Eisenhower, Ave 50, Washington St,
To North City limits.
Haul Date: 3/14/94 or 3/15/94
One Trip 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.
Signature of Applicant or Agent
Granite Conatruction 38-155 Monroe St. Indio 775-8327
Name of Applicant (please print) Business Address Telephone No.
Same
Name of Contractor and Job Foreman
On File
Contractor's License No.
On File
Business Address Telephone No.
On File
City Business License No.
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 $ 1( 1
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10.00
$ 10.00
Received by Date
210®
PERMIT VALIDATION
PERMIT NO. 2100
DATE APPROVED
3/14/94
EXPIRATION DATE 3/15/94
DATE ISSUED 3/14/94
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
Post -it" brand fax transmittal memo 7671F# 7P --g S
of
Tp
TO
From
Dept.
Phone #
Fax #
Fax
of