1507p` E:
nth proper validation
`:his form constitutes an
encroachment permit
CITY OF LA QUINTA
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: Au$uWt it 1999
Subdivision Improvement Permit — Class 1114
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 110Y4 15212 Mt Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION ' KM&tGU PC 400 ,Backhoe,
15. high, 11'10q nide• 165,000 lbs
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN r `
APPROXIMATE TIME OF,COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal' of all obstruction, materials, and debris, backfilling, com-
Haul Routet Rondo and Tampico to
Kashin8ton to 52 and 52 out of City
limits.
Haul Datet 8/7/92•
I
l
paction. and" placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
t
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. t
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.
(A �C24 1,
Signature of Ap-plicant or Agent
Gr=dte Conetruation "CoaManq . P.O. Box 9011 Palm Desertt CA 92255 775-8302
Name of Applicant (please print)' Business Address - K Telephone No.
Name of Contractor and Job Foreman , Business Address Telephone No.
On ]Tile On File ►
Contractor's License No.. City Business License No.
On rue � . 4n 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 1 507
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
10.00
r
$ 10.00
Date
PERMIT VALIDATION
PERMIT NO. 1507
DATE APPROVED 8/6/92
EXPIRATION DATE 8/7J92
DATE ISSUED ��� L 1�Cl/
By
��
Administrative Authority
Recorded by II TELEPHONE: (619) 564-2246
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