1485Ndf TE:
With proper validation r� Q
this form constitutes an �.
CITY OF 'LA QUINTA
encroachment permit ". •�.'.�
• APPLICATION' FOR PERMIT
PUBLIC WORKS, CONSTRUCTION ` (ENCROACHMENT)c
i 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:- j4fi 13," 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
l (Street address or Description of Location)
i' PURPOSE'OF CONSTRUCTION Move- Equipment 'Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 623'E Scraper, 15`16" high, r'
-11'10" wide 12,000 The Haul Routes Avenue @ city limits
to Washington to Londa
y' DIMENSION OF INSTALLATION OR REMOVAL
--
:Haul. Date:7/,1'/92
SIZE OF EXCAVATION, IF NEEDED '
' APPROXIMATE TIME'WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION e
ESTIMATED CONSTRUCTION COST $
i•
(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 4or property
happening or occurring as a proximate result of. any?work undertaken under the. permit "granted pursuant to this application.
• 1
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. r
z . Signature of Apphcani or Agent
Granite.Construetion P.O."Box 9011 .Palm Desert, CA 92255-9011 775-8327
Name of Applicant (please print) Business Address Telephone No.
Name of.Contractor and Job Foreman Business Address' Telephone No.
On File On Pile
• Contractor's License No. - " ' City Business License No.
-On- Nils On mile '
Applicant's Insurance, Company Policy Number �t
FEES: ' Subdivision Improvement Permit —'Class I II
Public improvements: 3% of estimated construction costs • - Q
Private improvements: 3% of estimated construction costs r '1 486
• Minor Improvement Permit — Class IV: See attached schedule 1
Inspection Fee $ PERMIT VALIDATION r
Permit Fee 10.00 � PERMIT NO. 1485 n�
s
Penalty DATE APPROVED 7/13/92 ( <
Cash Deposit -Surety Bond
if required EXPIRATION DATE 7/13/92
TOTAL: $ 10.00 7/13/92
DATE ISSUED
Receipt No.
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
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