14821 '.
7th proper validation Y
- J
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
Subdivision Improvement Permit — Class III
DATE: July 6, .1 992 e, Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTIONk f
(Street address or Description of Location) f
PURPOSE OF CONSTRUCTION '� Move Equipment ppropr
Sketch (attach construction plans if a .
� ) iate)
DESCRIPTION OF CONSTRUCTION Grinder, 10' Wide, Green
Weight, All else legalog Haul Route: Fernando to Eisenhower to
Washington and out of City Limits
DIMENSION,OF INSTALLATION OR REMOVAL $aul nates 7/7/92
SIZE OF EXCAVATION, IF NEEDED '
APPROXIMATE TIME WHEN'WORK WILL BEGIN ; r
APPROXIMATE TIME OF COMPLETION - F
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 Appl,ic t'or Age t.
Granite Construction P,O. Box 9011 Palm.Desert, CA 92255-961.1• 775-8302
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
On File On Fill
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 estirnated'coostruction costs 1�•, Q
Private improvements: 3% of estimated construction costsU
Minor Improvement Permit — Class IV: See attached schedule
�.. Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1482
DATE APPROVED 7/6/92
EXPIRATION DATE 7/7/92
DATE ISSUED 7/6/92
By
Administrative Authority
TELEPHONE: (619) 564-2246
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