1202,r+ '..—NOTE: i
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit _
APPLICATION. -FOR PERMIT ,
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
.y • • , � �' OF
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
t
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED. SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE:
August 30, .1991
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location),
� t '
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTJON QF CONSTRUCTION Barber Greene Paver y
11 6', wide Green Wt.' All else legal Route: Nogales & Juarez to -Bermudas
to 52 to City Limits
DIMENSION OF INSTALLATION OR REMOVAL —
�` +4AUL. ,Date: 9/3/91 t
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,'backfill ing, 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 roperty,
happening or occurring as a proximate result_ of any work undertaken under the permit granted pursuant tothis 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 onditions 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.
Tina Gracey
Signature of Applicant or Agent
Tarmac P.O.. Box 14050 Palm Desert, CA Fax. 342-7504
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
Applicant's Insurance Company. Policy Number
FEES: Subdivision Improvement. Permit — Class III `
Public improvements:, 3% of estimated •con`struction costs
Private improvements: 3% of estimated construction costs '
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
Permit Fee 10.00 PERMIT NO. 1202,'
Penalty 8/30/91
,Cash Deposit -Surety Bond DATE APPROVED
if.required EXPIRATION DATE 9/3/91
TOTAL: $ 10.00 DATE ISSUED 8/30/91
Receipt No. '
Received by Date By -
Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
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TRANSMISSION REPORT
THIS DOCUMENT (REDUCED SAMPLE ABOVE
WAS SENT
COUNT
# 2
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REMOTE STATION I.D.
START TIME
DURAT-ION
#PAGES
COMMENT
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8-30-91 3:41PM
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XEROX TELECOPIER 7020
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�9
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit U*OPT
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewersi water mains
and other like public works Improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: August 30, 1991
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION Barber Greene Paver
11 6' wide Green Wt. All else.legal
e
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Subdivision Improvement Permit - Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Route:* Nogales & Juarez to Bermudas
to 52 to City Limits
+4AUI.- Date: 9/3/91
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 against any and all
penalties, liabilities or loss resulting from clams 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. . '
Tina Gracey
Signature of Applicant or Agent
Tarmac P.O. Box 14050 Palm Desert CA Fax 342-7504
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
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit -Class III
Public improvements: 3% of estimated construction costs 1202 2 0 2
.Private improvements: 3% of estimated construction costs 1
Minor Improvement Permit - Class IV: Sie attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10.00
$ in -nn
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1202
DATE APPROVED 8/30/91
EXPIRATION DATE 9/3/91
DATE ISSUED- 8/30/91
By.1 jA,
Administrative Authority
TELEPHONE: (619) 564-2246