1521NOTE':
iioA'
valida
I
With proper �4 2
this form constitutes an
encroachment permit CITY OF LA QUINTA �
APPLICATION • FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) �� w
OF
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: Aubilt 25. 1992 .ti Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION �r
(Street address or Description of Location) '
PURPOSE OF CONSTRUCTION Mo•vi equip Tout Sketch (attach construction plans if appropriate)-
DESCRIPTION OF CONSTRUCTION Paver 11'6'1 Vida* $4,000 ("
lbs, all else legal., ROM; Washi1tgton from Ndrtheta City
limits to La Fonda.
X
DIMENSION OF INSTALLATION OR REMOVAL t f
MOVE DATBs 8/26/92 a ,
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 agents„off icers, 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 Applicant or Agent
Granite-Construction P.O..8ox 9011*- Palm Desert-, CA'9225
Name of Applicant (please print) Business Address ',. ; Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
k' = Ott fila
Contractor's• Licerise No. City Business License No'•
Applicant's,lnsurance Company _ Policy Number '
FEES: Subdivision Improvement Permit - Class 111
-Public improvements: 3% of estimated construction costs
Private, improvements: 3% of estimated construction costs
Minor lmprovement'Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 10.00'
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
$ 10.00
Received by Date
Recorded by
1521
PERMIT VALIDATION
PERMIT NO. 1521
DATE APPROVED 8/25/92
EXPIRATION DATE 8/26/92
DATE IS OED 8/25/92
By
Administrative Aut ority
TELEPHONE: (619) 564-2246
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