1550NOTE:
With propenvalidation
this form constitutes an
encroachment permit
0
CITY OF LA QUINTA r
'� • 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,%W&ks improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE:" 'September 16, 1992Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION "
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION '�dVA equipment Sketch (attach construction plans if appropriate)
+IDESCRIPTION OF CONSTRUCTION 966 loader - 10wide
15-6" high 100.000 weight' ROUTS: 50th from Jefferson to
Washington,
DIMENSION OF INSTALLATION OR REMOVAL '
.
SIZE OF EXCAVATION, IF NEEDED .. "
APPROXIMATE TIME WHEN°WORK WILL BEGIN '
• Y ) Al
APPROXIMATE TIME OF COMPLETION �-
ESTIMATED CONSTRUCTION COST $
(including- removal of all obstruction, materials, and debris, backfilling, com- '
pactiori 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 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.
f
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
LaxQuinta and to pay for any additional replacement necessary as the result of this work. F'. .
Signature of Applicant or Agent
Granite ConatruCtion P.O. Box 9011 • Palm Desert, CA 93255 775-8302
Name of Applicant (please print) _ Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
On file
*Contractor's License No. City Business License No. '
+ Applicant's Insurance Company . Policy, Number '
'FEES: 'Subdivision Improvement Permit -Class III
•� K
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
E
Minor Improvement Permit — Class IV: See attached schedule
$I
10.00
$ 10.00
Received by Date
( Recorded by
0
1,550
t.
PERMIT VALIDATION
PERMIT NO. 1550
DATE APPROVED 9/16/92
EXPIRATION DATE
DATE I d 9/16/92
By O
Administra ve Authority
TELEPHONE: (619) 564-2246
Inspection Fee
'
Permit Fee
Penalty
`
Cash Deposit -Surety Bond
+ '
if required
e
TOTAL:
Receipt No.
$I
10.00
$ 10.00
Received by Date
( Recorded by
0
1,550
t.
PERMIT VALIDATION
PERMIT NO. 1550
DATE APPROVED 9/16/92
EXPIRATION DATE
DATE I d 9/16/92
By O
Administra ve Authority
TELEPHONE: (619) 564-2246
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