1489NOTE:
' With proper validation
this form constitutes an
encroachment permit -
CITY OF LA QUINTA
r APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
BMW..4'dw''I,MLuryY1�.�:+A;.V+a�W.IL&2i►'rW.te.abt.r.]�-rm+ra . N w.• •. •"ten • '
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
1'
DATE: July 22, 1992 Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION ''Move Equipment Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION Paver, 11'6" Wide, Haul Route: Washington from Fred
84,000 lbs, all else legal Waring to Avenue 52 to Durango and.
Velasco
DIMENSION OF INSTALLATION OR REMOVAL
Haul Date: 7/22/92 or 7/23/92
One (1) day only
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, 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 a9 representatives employees, agents, officers resentatives and any Y harmless from and against 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. y
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the Cityrof
La Quinta and to pay for any additional replacement necessary as the result of this work. .
Signature of Applica�t or Agent
Granite Construction P.O. Box 9011 Palm Desert, CA 92255 775-8302
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. Cit Business License No.
On File 6n File .. .
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I ,
r
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
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
Recorded by
Date
109
• � r
PERMIT VALIDATION
PERMIT NO. 148.9
DATE APPROVED 7/22/92
EXPIRATION DATE 7/23/92
DAT ISSUED 7/22/92
By
Administrative Authority
TELEPHONE: (619) 564-2246
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