1575i
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
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: October 14, 1992
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVA NUip"nt
DESCRIPTION OF CONSTRUCTION PWMV 106" wide 84,000
lbs, all else lasal
DIMENSION OF INSTALLATION OR REMOVAL
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
ROVMt $onora and bias to Bermudas
to 52 to Washington and north
out of City limits.
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DATE: 10/14 or 10/15
SIZE OF EXCAVATION, IF NEEDED I an omit
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, 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.
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. Box 9011 Pals Deeert, RA 775-6302
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.
On file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class II I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
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Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$
10,00
$ 1.0:00
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. -,1575
DATE APPROVED 10/14/92
EXPIRATION DATE 10/15/92
DATE I SU'�E ,10 14/92
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By r
Administrative Authority
TELEPHONE: (619) 564-2246