1558k' .NOTE', w
` X With proper validation 011
this form'constitutes anCITY OF LA.QUINTA
>x
• encroachment permit.
' APPLICATION FOR PERMIT
s PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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
` I t' • • Subdivision Improvement Permit — Class I I I
Sep>relab+eic 25,' 1,992 ;
s :DATE: Minor Improvement Permit Class IV
:LOCATION OF CONSTRUCTION
(Street address or?Description of Location)
_
P . `.PURPOSE OF. CONSTRUCTION�� $gi><lpmeiit•-u « Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 623 0 rapbr, 15'6' 118h. -A�ul,,Routet $onolaa & Diat to
11`10" -Vida, Purple Weixht 125,000' 'lbe .ti �.
lormudas to 52nd atid.out og City
,r DIMENSION,OF INSTALLATIONIOR,REMOVAL ;
a , _ ; . •� k Rain. batos 9/28/92 � �`'�• '
"SIZE OF EXCAVATION; IF NEEDED
r 'APPROXIMATE TIME WHEN WORK WILL BEGIN
,APPROXIMATE TIME OF COMPLETION r�
�? ESTIMATED CONSTRUCTION COST $
(Including removal of•all obstruction; materials, and debris, backfilling, com-
l. ,paction and placing permanent resurfacing and/or replacing improvements)
�In considerat•ion of the granting of this permit, the applicant hereby agrees to: s
T t` i
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 iri advance of the time when work will be started.
i
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. «
Itif(LA CS�LA
s Signature of Applicant or Agetht
5` Granitd Gongiruatign Coiospany PA. 9011. Palm Aeaezt, CA 92255 775-8302
t ) Name of Applicant (please print) 'Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No. _
On Bild On File
.Contractor's License No. City Business License No.
.On File. � On File
Applicant's Insurance Company Policy Number w
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs
s Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached'schedule
Inspection Fee. $ r PERMIT VALIDATION w
Permit" 10.00. 10.00. PERMIT NO. 1558 '
Penalty DATE A PROVED 9/25/92
Cash Deposit -Surety Bond Ile,
if required EXPIRATION DATE 9/28/92
TOTAL: $ 10.00 9/25/92
DATE ISSUED _
Receipt No. By
Received by + Date Administrative Authority
f
Recorded by TELEPHONE: (619) 564-2246