1525i
NPTE:
With proper validation
this 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: August 28, 1992
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
PURPOSE OF CONSTRUCTION Move ECIAIRaent
DESCRIPTION OF CONSTRUCTION 623E Scragar. 1516" High
11110" Wide. 110,000 lbs.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
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:
Haul. Routes Avenue 52 from City Limits
to Sonora 6 Juarez,
Haul Dates 8/31/92
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
4
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.
-ri' in Q
Signature of A plycant or Agent
Granite Construction P.0. Box 9011 Palm Desert, CA 92235011 775-8302
Name of Applicant (please print) Business Address Telephone No.
Same
Name of Contractor and Job Foreman
Oa Fila
Contractor's License No.
Business Address Telephone No.
On File
City Business License No.
On File On File t
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
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
10.00
$ 10.00
Date
1 525
PERMIT VALIDATION
PERMIT NO. 1525
DATE APPROVED
8/28/92
EXPIRATION DATE 8/31/92
DATE ISSUED 80p/��28i/92
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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